Provider Demographics
NPI:1245580521
Name:MILLER, TAMMY M (PSYD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 PRIEST BRIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2472
Mailing Address - Country:US
Mailing Address - Phone:443-937-7089
Mailing Address - Fax:800-353-1668
Practice Address - Street 1:2110 PRIEST BRIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2472
Practice Address - Country:US
Practice Address - Phone:443-937-7089
Practice Address - Fax:443-292-4570
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2012-64390200000X
MD05998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program