Provider Demographics
NPI:1568113181
Name:MILLER, CHANTEL (MFT, PPS)
Entity Type:Individual
Prefix:MISS
First Name:CHANTEL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 PRICE ST # 124
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2529
Mailing Address - Country:US
Mailing Address - Phone:562-884-1631
Mailing Address - Fax:
Practice Address - Street 1:901 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6603
Practice Address - Country:US
Practice Address - Phone:805-925-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X, 106H00000X
CA103TS0200X
CAMFC41469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool