1144398322 NPI number — JASON THOMAS MILLER MSW, LCSW

Table of content: JASON THOMAS MILLER MSW, LCSW (NPI 1144398322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144398322 NPI number — JASON THOMAS MILLER MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JASON
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
LISA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144398322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 COLLEGE BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-636-8566
Provider Business Mailing Address Fax Number:
888-515-3097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-636-8566
Provider Business Practice Location Address Fax Number:
888-515-3097
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  002081 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4001 . This is a "LSCSW" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1144398322 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002081 . This is a "LCSW" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".