Provider Demographics
NPI:1629584842
Name:MILLER, JOHNNY FRANKLIN (CRADC)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:FRANKLIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0157
Mailing Address - Country:US
Mailing Address - Phone:573-663-2313
Mailing Address - Fax:573-663-2441
Practice Address - Street 1:315 W MULBERRY,
Practice Address - Street 2:SUITE A
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663-0327
Practice Address - Country:US
Practice Address - Phone:573-546-0602
Practice Address - Fax:573-546-0624
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor