Provider Demographics
NPI:1144888355
Name:MILLER, MARK BRETCHING (LMFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BRETCHING
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402A BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4609
Mailing Address - Country:US
Mailing Address - Phone:502-894-0234
Mailing Address - Fax:502-894-9858
Practice Address - Street 1:1402A BROWNS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4609
Practice Address - Country:US
Practice Address - Phone:502-894-0234
Practice Address - Fax:502-894-9858
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0827106H00000X, 101YM0800X
KY241563101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health