Provider Demographics
NPI:1275628281
Name:MILLER, AYISHA R (MS)
Entity Type:Individual
Prefix:
First Name:AYISHA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AYISHA
Other - Middle Name:
Other - Last Name:KELLYBREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1312 DONAGHEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3807
Mailing Address - Country:US
Mailing Address - Phone:501-336-8300
Mailing Address - Fax:
Practice Address - Street 1:1312 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3807
Practice Address - Country:US
Practice Address - Phone:501-366-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0409039101YM0800X
AR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty