Provider Demographics
NPI:1467662338
Name:MILLER, BOBBI JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BOBBI
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WOODLAWN AVENUE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366
Mailing Address - Country:US
Mailing Address - Phone:636-379-1779
Mailing Address - Fax:
Practice Address - Street 1:801 S WOODLAWN
Practice Address - Street 2:SUITE 29
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7646
Practice Address - Country:US
Practice Address - Phone:636-379-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200836106H00000X
MO2008034250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist