Provider Demographics
NPI:1245573054
Name:MILLER, DELL MELTON (CADCII)
Entity Type:Individual
Prefix:MR
First Name:DELL
Middle Name:MELTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-1579
Mailing Address - Country:US
Mailing Address - Phone:503-474-2024
Mailing Address - Fax:503-474-4454
Practice Address - Street 1:410 NE 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4621
Practice Address - Country:US
Practice Address - Phone:503-474-2024
Practice Address - Fax:503-474-4454
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-R-15101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165726Medicaid