Provider Demographics
NPI:1144898669
Name:MILLER, JILLIANNE MARIE (LPC-MHSP, TEMP)
Entity type:Individual
Prefix:
First Name:JILLIANNE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC-MHSP, TEMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5268
Mailing Address - Country:US
Mailing Address - Phone:931-218-6100
Mailing Address - Fax:931-477-2377
Practice Address - Street 1:600 S ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5268
Practice Address - Country:US
Practice Address - Phone:931-218-6100
Practice Address - Fax:931-477-2377
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional