Provider Demographics
NPI:1164736690
Name:MILLER, MARVIN STEVEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:STEVEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 NETHERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4649
Mailing Address - Country:US
Mailing Address - Phone:314-382-9318
Mailing Address - Fax:314-338-6860
Practice Address - Street 1:2870 NETHERTON DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4649
Practice Address - Country:US
Practice Address - Phone:314-382-9318
Practice Address - Fax:314-338-6860
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional