Provider Demographics
NPI:1073912754
Name:MILLER, LATOYIA TENNELLE
Entity Type:Individual
Prefix:MRS
First Name:LATOYIA
Middle Name:TENNELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 ROWAYTON CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5543
Mailing Address - Country:US
Mailing Address - Phone:561-260-9290
Mailing Address - Fax:
Practice Address - Street 1:1171 ROWAYTON CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5543
Practice Address - Country:US
Practice Address - Phone:561-260-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling