Provider Demographics
NPI:1154505634
Name:THOMAS T MILLER LIFE COACH CONSULTANT LLC
Entity Type:Organization
Organization Name:THOMAS T MILLER LIFE COACH CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:419-238-6646
Mailing Address - Street 1:4745 ESTERO BLVD
Mailing Address - Street 2:UNIT 305
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-3981
Mailing Address - Country:US
Mailing Address - Phone:239-765-6906
Mailing Address - Fax:239-765-6906
Practice Address - Street 1:10085 UPP RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-8406
Practice Address - Country:US
Practice Address - Phone:419-238-6646
Practice Address - Fax:419-238-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1381251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0257529Medicaid
OH34131107400OtherOH WORKERS COMP
OH34131107400OtherOH WORKERS COMP
OHR71341Medicare UPIN