Provider Demographics
NPI:1487031811
Name:MILLER, MICHAEL II (BSL)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MILLER
Suffix:II
Gender:M
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAHANTONGO ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3010
Mailing Address - Country:US
Mailing Address - Phone:570-622-6417
Mailing Address - Fax:
Practice Address - Street 1:221 MAHANTONGO ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3010
Practice Address - Country:US
Practice Address - Phone:570-622-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst