Provider Demographics
NPI:1477040707
Name:MILLER, DAJUAN (MA QMHP)
Entity Type:Individual
Prefix:
First Name:DAJUAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3130
Mailing Address - Country:US
Mailing Address - Phone:708-995-3793
Mailing Address - Fax:708-788-8535
Practice Address - Street 1:6415 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3130
Practice Address - Country:US
Practice Address - Phone:708-995-3793
Practice Address - Fax:708-788-8535
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health