Jordan David Miller, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60505994 Issued in WA

Practice address

17150 W Main St Ste B
Monroe, WA 98272-1918

Phone

(360) 294-8480

NPI assigned

Jan 24, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Conquer Addiction PLLC

  • Multi-Specialty Clinic/Center
  • Monroe, WA
  • NPI 1255001624
  NPD
• Conquer Addiction PLLC

  • Adult Mental Health Clinic/Center
  • Monroe, WA
  • NPI 1689494262
  NPD

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1831805753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 W MAIN ST STE 102",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722031",
            "telephone_number": "206-552-0882",
            "fax_number": "949-955-5758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 W MAIN ST STE B",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721918",
            "telephone_number": "360-294-8480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16104 Goldbar Blvd",
            "address_purpose": "LOCATION",
            "city": "Gold Bar",
            "state": "WA",
            "postal_code": "982519577",
            "country_code": "US",
            "telephone_number": "425-698-3443",
            "fax_number": "425-984-0995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JORDAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "SUDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60505994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loretta Ann Meisburger, LMP
• Stephanie Marie Melvin, LMP
• Michael S. Eickerman M.D. PS
• Darlene Patricia Miller-Turner, RN
• Jamie L Miller, LMP
• Lisa Marie Miller, ARNP
• Nicholas Allen Miller, DDS
• Sabrena Miller
• Kyung Eun Min, MD
• Mindful Sasquatch PLLC

• Addiction (Substance Use Disorder) Counselor in Monroe, WA
• Providers in Monroe, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.