Provider Demographics
NPI:1538373865
Name:MILLER, LETHA FAYE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LETHA
Middle Name:FAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LETHA
Other - Middle Name:FAYE
Other - Last Name:TIMBLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6408 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1302
Mailing Address - Country:US
Mailing Address - Phone:813-625-5743
Mailing Address - Fax:
Practice Address - Street 1:4244 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1140
Practice Address - Country:US
Practice Address - Phone:727-303-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004278000Medicaid
FLSW7745OtherSTATE OF FL - DEPT OF HEALTH