Provider Demographics
NPI:1336306893
Name:MILLER, NOELLE (MFT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SELBY AVE
Mailing Address - Street 2:#402
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5700
Mailing Address - Country:US
Mailing Address - Phone:310-766-1947
Mailing Address - Fax:310-474-7275
Practice Address - Street 1:1601 SELBY AVE
Practice Address - Street 2:#402
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5700
Practice Address - Country:US
Practice Address - Phone:310-276-2668
Practice Address - Fax:310-474-7275
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist