| Mary Ellen Miller, Ms, Lpc, Llc | |
|
W10445 State Road 16 Lot 21 Portage WI 53901-9488 | |
| (608) 617-8419 | |
| Not Available |
| Full Name | Mary Ellen Miller, Ms, Lpc, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | W10445 State Road 16 Lot 21, Portage, Wisconsin |
| Authorized Official Name and Position | Mary Ellen Ellen Miller Ms Miller (DIRECTOR) |
| Authorized Official Contact | 6086178419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Ellen Miller, Ms, Lpc, Llc W10445 State Road 16 Lot 21 Portage WI 53901-9488 Ph: (608) 617-8419 | Mary Ellen Miller, Ms, Lpc, Llc W10445 State Road 16 Lot 21 Portage WI 53901-9488 Ph: (608) 617-8419 |
| NPI Number | 1518762756 |
|---|---|
| Provider Enumeration Date | 02/13/2025 |
| Last Update Date | 02/13/2025 |
| Certification Date | 02/13/2025 |
| Medicare PECOS PAC ID | 0143744631 |
|---|---|
| Medicare Enrollment ID | O20250407000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518762756 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mary Ellen Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770659815 PECOS PAC ID: 5698902666 Enrollment ID: I20240522000655 |
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Columbia County Hhsd Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 E Mullett St, Portage, WI 53901 Phone: 608-742-9227 Fax: 608-742-9700 |