Provider Demographics
NPI:1235585696
Name:MILLER, MARIANNE M (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 CARMEL MOUNTAIN RD
Mailing Address - Street 2:UNIT 374
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2813
Mailing Address - Country:US
Mailing Address - Phone:858-699-3754
Mailing Address - Fax:
Practice Address - Street 1:10455 POMERADO RD
Practice Address - Street 2:DALEY HALL, ROOM 206D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1717
Practice Address - Country:US
Practice Address - Phone:858-699-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87667106H00000X
TX5209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist