| Doctor Name: | MR. JONATHAN MILLER |
| NPI Number: | 1083941066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, PLPC |
| License Number: | 2008037618 |
| Business Practice Address: | 18614 Whiskey Creek Rd Wildwood, MO - 630692530 |
| Business Phone Number: | 3145043828 |
| Business Fax Number: | |
| Mailing Address: | Po Box 220081, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631220081 |
| Phone Number: | 3145043828 |
| Fax Number: | |
| NPI Enumeration Date: | 11/11/2009 |
| NPI Last Update Date: | 11/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2008037618 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |