Provider Demographics
NPI: | 1619996162 |
---|---|
Name: | MILLER, EMILY B (MSW) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | EMILY |
Middle Name: | B |
Last Name: | MILLER |
Suffix: | |
Gender: | F |
Credentials: | MSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 400 MAYNARD ST |
Mailing Address - Street 2: | SUITE #503 |
Mailing Address - City: | ANN ARBOR |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48104-2440 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 734-761-5347 |
Mailing Address - Fax: | 734-663-4327 |
Practice Address - Street 1: | 400 MAYNARD ST |
Practice Address - Street 2: | SUITE #503 |
Practice Address - City: | ANN ARBOR |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48104-2440 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-761-5347 |
Practice Address - Fax: | 734-663-4327 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-07-18 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6801001068 | 1041C0700X |
MI | 4101005568 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Not Answered | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | BM810045 | Other | MCARE |