Provider Demographics
NPI:1265823652
Name:ROBBIE MILLER, MAC, SAP, CADC III
Entity Type:Organization
Organization Name:ROBBIE MILLER, MAC, SAP, CADC III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, SAP, CADC III
Authorized Official - Phone:503-816-0345
Mailing Address - Street 1:PO BOX 10924
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-0924
Mailing Address - Country:US
Mailing Address - Phone:503-816-0345
Mailing Address - Fax:
Practice Address - Street 1:811 NW 20TH AVE
Practice Address - Street 2:SUITE 103C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1443
Practice Address - Country:US
Practice Address - Phone:503-816-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health