Provider Demographics
NPI:1326158577
Name:MILLER, RONALD COLBY (PSYD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:COLBY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 S ALMA SCHOOL RD
Mailing Address - Street 2:172
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3009
Mailing Address - Country:US
Mailing Address - Phone:602-324-4676
Mailing Address - Fax:480-209-1063
Practice Address - Street 1:1745 S ALMA SCHOOL RD
Practice Address - Street 2:172
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3009
Practice Address - Country:US
Practice Address - Phone:602-324-4676
Practice Address - Fax:480-209-1063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374415OtherMHN
AZ910184OtherEVERCARE SELECT
AZ910184OtherMERCY CARE
AZ6100810OtherEVERCARE CHOICE
AZ202622779-85016-A002OtherTRICARE/TRIWEST
AZ7000831OtherAETNA
AZAZ0623430OtherBLUE CROSS BLUE SHIELD
AZ9402957OtherPHCS
AZ374415OtherMHN
AZP00283896Medicare ID - Type UnspecifiedRAILROAD