Provider Demographics
NPI:1467799882
Name:MILLER, SANDRA MAUREEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MAUREEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:MAUREEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 4103
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690
Mailing Address - Country:US
Mailing Address - Phone:949-572-7600
Mailing Address - Fax:949-451-5467
Practice Address - Street 1:17772 IRVINE BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:949-572-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist