Provider Demographics
NPI:1588192322
Name:MILLER, BILAAL JABRIEL
Entity Type:Individual
Prefix:MR
First Name:BILAAL
Middle Name:JABRIEL
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 1:3012 ZACHRY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5263
Mailing Address - Country:US
Mailing Address - Phone:318-388-0293
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON ST STE 401
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6714
Practice Address - Country:US
Practice Address - Phone:318-388-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty