1821285453 NPI number — RENAE ELIZABETH MILLER LPC, MSMFT

Table of content: RENAE ELIZABETH MILLER LPC, MSMFT (NPI 1821285453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821285453 NPI number — RENAE ELIZABETH MILLER LPC, MSMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
RENAE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, MSMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONNESON
Provider Other First Name:
RENAE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, MSMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821285453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3248 VANDEVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEKIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61554-6257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-347-5579
Provider Business Mailing Address Fax Number:
309-347-4264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3248 VANDEVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEKIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61554-6257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-347-5579
Provider Business Practice Location Address Fax Number:
309-347-4264
Provider Enumeration Date:
09/27/2007

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: 101YP2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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