1164790747 NPI number — MRS. HEATHER RENEE MILLER LMSW

Table of content: MRS. HEATHER RENEE MILLER LMSW (NPI 1164790747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164790747 NPI number — MRS. HEATHER RENEE MILLER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
HEATHER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERSER
Provider Other First Name:
HEATHER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164790747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 WOOD HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49237-9773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-666-0533
Provider Business Mailing Address Fax Number:
810-600-7935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 WOOD HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49237-9773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-666-0533
Provider Business Practice Location Address Fax Number:
586-600-7935
Provider Enumeration Date:
12/09/2011

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:  601081151 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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