Provider Demographics
NPI:1417909177
Name:MILLER, DEBORAH COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:COLLEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 TERRACE RD NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6779
Mailing Address - Country:US
Mailing Address - Phone:763-785-8111
Mailing Address - Fax:763-785-6946
Practice Address - Street 1:199 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5831
Practice Address - Country:US
Practice Address - Phone:763-785-8111
Practice Address - Fax:763-785-6946
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN717093900Medicaid