Provider Demographics
NPI:1366596157
Name:MILLER, PATRICIA J (LCPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CEDAR COURT
Other - Middle Name:
Other - Last Name:COUNSELING CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14405 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2801
Mailing Address - Country:US
Mailing Address - Phone:708-403-1770
Mailing Address - Fax:
Practice Address - Street 1:3759 W 95TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2000
Practice Address - Country:US
Practice Address - Phone:708-403-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12016101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional