Provider Demographics
NPI:1801175229
Name:MILLER, BRUCE LEE (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:660-826-4774
Mailing Address - Fax:888-979-8868
Practice Address - Street 1:17571 N DAM ACCESS RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-6396
Practice Address - Country:US
Practice Address - Phone:660-438-2717
Practice Address - Fax:660-438-2313
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20240499671041C0700X
UT6885651-3503171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker