Provider Demographics
NPI:1003564550
Name:MILLER PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:MILLER PSYCHIATRIC SERVICES, LLC
Other - Org Name:MILLER PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:330-398-6420
Mailing Address - Street 1:5547 MAHONING AVE # 187
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2316
Mailing Address - Country:US
Mailing Address - Phone:330-398-6420
Mailing Address - Fax:
Practice Address - Street 1:196 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2139
Practice Address - Country:US
Practice Address - Phone:330-398-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty