Provider Demographics
NPI:1316360050
Name:MILLER, PAULA HOLMES (PH D)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:HOLMES
Last Name:MILLER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE
Mailing Address - Street 2:SUITE 417
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4426
Mailing Address - Country:US
Mailing Address - Phone:901-509-8468
Mailing Address - Fax:901-509-8470
Practice Address - Street 1:4646 POPLAR AVE
Practice Address - Street 2:SUITE 417
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4426
Practice Address - Country:US
Practice Address - Phone:901-509-8468
Practice Address - Fax:901-509-8470
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional