Jackie L Miller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7632-125 Issued in WI

Practice address

1517 E Huebbe Pkwy Ste a
Beloit, WI 53511-1795

Phone

(608) 291-5891

Fax

(608) 713-9040

NPI assigned

Mar 15, 2017

Reactivated

Feb 22, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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.

• Holistic Counseling Services, LLC

  • Professional Counselor
  • Beloit, WI
  • NPI 1033773734

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1922549567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1517 E HUEBBE PKWY STE A",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111795",
            "telephone_number": "608-291-5891",
            "fax_number": "608-713-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 E HUEBBE PKWY STE A",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111795",
            "telephone_number": "608-291-5891",
            "fax_number": "608-713-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JACKIE",
        "middle_name": "L",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-15",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "deactivation_date": "2019-02-14",
        "reactivation_date": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7632-125",
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "WI",
            "license": "NA131596",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7632-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100086806",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Midwest Pain Treatment Center LLC
• Hailee Mikkelsen, NP-C
• Cheryl M Miller, MD
• Cole Miller
• Hannah Miller
• Jada Miller
• Jaimee Miller
• James R Miller, MD
• Kathy Miller
• Nicolette Ann Miller, LCSW

• Professional Counselor in Beloit, WI
• Providers in Beloit, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.