Basic Information
| Provider Information | |||||||||
| NPI: | 1144888355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | BRETCHING | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402A BROWNS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028940234 | ||||||||
| FaxNumber: | 5028949858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1402A BROWNS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028940234 | ||||||||
| FaxNumber: | 5028949858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2019 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0827 | KY | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 241563 | KY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 241563 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 0827 | KY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.