Individual
MR. MARK E. MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW, LISW, LSCSW
Contact information
Practice address
12035 Q ST, OMAHA, NE 68137-3542
(402) 991-0611
(402) 991-6228
Mailing address
12035 Q STREET, OMAHA, NE 68137-3542
(402) 991-0611
(402) 991-6228
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1199
NE
1041C0700X
Clinical Social Worker
05745
KS
1041C0700X
Clinical Social Worker
06756
IA
1041C0700X
Clinical Social Worker
1413
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB158001
MEDICARE PTAN
IA
01
—
NA3245001
MEDICARE PTAN
NE
Enumeration date
08/21/2006
Last updated
08/22/2024
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