Individual
JEAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LMFT
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002284A
IN
106H00000X
Marriage & Family Therapist
35001251A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202159
ANTHEM
IN
Enumeration date
06/23/2006
Last updated
03/08/2023
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