Provider Demographics
NPI:1922837277
Name:MILLER, MADELINE (TLMHC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N ANKENY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4163
Mailing Address - Country:US
Mailing Address - Phone:515-704-0174
Mailing Address - Fax:515-310-4003
Practice Address - Street 1:1605 N ANKENY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4163
Practice Address - Country:US
Practice Address - Phone:515-704-0174
Practice Address - Fax:515-310-4003
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health