1871869198 NPI number — MISS AMANDA G MILLER LCSW

Table of content: MISS AMANDA G MILLER LCSW (NPI 1871869198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871869198 NPI number — MISS AMANDA G MILLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
AMANDA
Provider Middle Name:
G
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871869198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353-1348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-404-7686
Provider Business Mailing Address Fax Number:
859-274-4312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MERCY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40336-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-726-2151
Provider Business Practice Location Address Fax Number:
606-726-2149
Provider Enumeration Date:
03/30/2012

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: 1041C0700X , with the licence number:  5017 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 5017 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100499680 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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