Provider Demographics
NPI:1003963752
Name:MILLER, GINNY D (LMHC)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PELLY AVE N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5714
Mailing Address - Country:US
Mailing Address - Phone:425-786-3737
Mailing Address - Fax:
Practice Address - Street 1:119 PELLY AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5714
Practice Address - Country:US
Practice Address - Phone:425-786-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60067248101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor