Provider Demographics
NPI:1497937148
Name:MILLER, JAMES HENRY
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HENRY
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19328 104TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6459
Mailing Address - Country:US
Mailing Address - Phone:253-988-8954
Mailing Address - Fax:253-875-3638
Practice Address - Street 1:9108 LAKEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3949
Practice Address - Country:US
Practice Address - Phone:253-581-6202
Practice Address - Fax:253-581-6196
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00011927320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00011927OtherREGISTERED COUNSELOR