Provider Demographics
NPI:1437540465
Name:MILLER, TAMMY (LSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 S COMMONS CIR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-3218
Mailing Address - Country:US
Mailing Address - Phone:330-417-4670
Mailing Address - Fax:
Practice Address - Street 1:21515 CHAGRIN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5339
Practice Address - Country:US
Practice Address - Phone:330-556-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 00125751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical