Provider Demographics
NPI:1558878769
Name:MILLER, ROBERT CORY (BED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CORY
Last Name:MILLER
Suffix:
Gender:M
Credentials:BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NE BROSI ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-5522
Mailing Address - Country:US
Mailing Address - Phone:541-621-6297
Mailing Address - Fax:
Practice Address - Street 1:300 JERRYS DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1132
Practice Address - Country:US
Practice Address - Phone:541-673-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health