Provider Demographics
NPI:1548542970
Name:MILLER, STACY (LPCC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BALLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:285 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7620
Mailing Address - Country:US
Mailing Address - Phone:146-454-6559
Mailing Address - Fax:
Practice Address - Street 1:285 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7620
Practice Address - Country:US
Practice Address - Phone:614-454-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000135101YM0800X
OHE.1000135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid