Provider Demographics
NPI:1063825727
Name:MILLER, DELBERT W
Entity Type:Individual
Prefix:MR
First Name:DELBERT
Middle Name:W
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 1:80 N TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9748
Mailing Address - Country:US
Mailing Address - Phone:360-879-2008
Mailing Address - Fax:360-877-2090
Practice Address - Street 1:551 N TRIBAL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NA
Practice Address - State:WA
Practice Address - Zip Code:98584-9748
Practice Address - Country:US
Practice Address - Phone:360-877-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP00001416101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)