Provider Demographics
NPI:1730947789
Name:MILLER, LASYDNIA SHANTELL
Entity type:Individual
Prefix:
First Name:LASYDNIA
Middle Name:SHANTELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ASHLAND CITY RD APT 726
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1602
Mailing Address - Country:US
Mailing Address - Phone:731-432-1632
Mailing Address - Fax:
Practice Address - Street 1:1925 ASHLAND CITY RD APT 726
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1602
Practice Address - Country:US
Practice Address - Phone:731-432-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician