Provider Demographics
NPI:1013366277
Name:MILLER, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069-0072
Mailing Address - Country:US
Mailing Address - Phone:504-813-0071
Mailing Address - Fax:
Practice Address - Street 1:75 DOMINICAN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3400
Practice Address - Country:US
Practice Address - Phone:985-224-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service