Individual
MS. MARY ELLEN MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
702 N BLACKHAWK AVE, SUITE205, MADISON, WI 53705-3357
(608) 233-3037
(608) 233-5893
Mailing address
W10445 STATE ROAD 16 LOT 21, PORTAGE, WI 53901-9488
(608) 617-8419
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2321-125
WI
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
2321-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39206700
—
WI
05
—
K401105626
—
WI
Enumeration date
11/28/2006
Last updated
02/12/2025
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