Provider Demographics
NPI:1902970064
Name:MILLER, JEFFERY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MCHENRY RD
Mailing Address - Street 2:SUITE #122
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1382
Mailing Address - Country:US
Mailing Address - Phone:847-913-0393
Mailing Address - Fax:847-913-9630
Practice Address - Street 1:1401 MCHENRY RD
Practice Address - Street 2:SUITE #122
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1382
Practice Address - Country:US
Practice Address - Phone:847-913-0393
Practice Address - Fax:847-913-9630
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional