Provider Demographics
NPI:1144117151
Name:MILLER, KEITH ALAN
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
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 1:34880 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9307
Mailing Address - Country:US
Mailing Address - Phone:951-704-2020
Mailing Address - Fax:
Practice Address - Street 1:34880 REBECCA ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9307
Practice Address - Country:US
Practice Address - Phone:951-704-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health