Provider Demographics
NPI:1376983858
Name:MILLER, LYNDSEY NICHOLE
Entity Type:Individual
Prefix:DR
First Name:LYNDSEY
Middle Name:NICHOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GOVERNOR CARLOS CAMACHO ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931
Mailing Address - Country:US
Mailing Address - Phone:671-647-5328
Mailing Address - Fax:671-647-0250
Practice Address - Street 1:790 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96931
Practice Address - Country:US
Practice Address - Phone:671-647-5328
Practice Address - Fax:671-647-0250
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUCP-037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical