Provider Demographics
NPI:1578941092
Name:MILLER, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
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 1:2210 FULLERTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2048
Mailing Address - Country:US
Mailing Address - Phone:317-366-9129
Mailing Address - Fax:
Practice Address - Street 1:5435 EMERSON WAY
Practice Address - Street 2:SUITE 210.1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1466
Practice Address - Country:US
Practice Address - Phone:317-366-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst