Shawn Jeffry Miller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178018604 Issued in IL

Practice address

218 E Cherry Ridge Rd
Peoria, IL 61614-5117

Phone

(309) 253-0216

NPI assigned

Jan 3, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  Medicare reassignment Care Compare group NPD
• Psychology Specialists LTD

  dba LifeStance Health

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)
• Psychology Specialists LTD

  dba LifeStance Health

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1003473448
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1033989751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 E CHERRY RIDGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145117",
            "telephone_number": "309-253-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 E CHERRY RIDGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145117",
            "telephone_number": "309-253-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SHAWN",
        "middle_name": "JEFFRY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178018604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Miller, PT
• Micky Miller
• Morgan Anne-Marie Miller, FNP-C
• Richard Andrew Miller, PA-C
• Richard F Miller, M.D.
• Tim C Miller, MD
• Timberly Miller, LCPC
• William Kyle Miller
• Callie Milligan
• Drew Milliken, HIS

• Professional Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.