Provider Demographics
NPI:1073690855
Name:MILLER, BRYAN G (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S 70TH
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4276
Mailing Address - Country:US
Mailing Address - Phone:402-483-1936
Mailing Address - Fax:402-483-7314
Practice Address - Street 1:4501 S 70TH
Practice Address - Street 2:SUITE 120
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4276
Practice Address - Country:US
Practice Address - Phone:402-483-1936
Practice Address - Fax:402-483-7314
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080115226Medicaid