Provider Demographics
NPI:1639342793
Name:MILLER, PHILIP (MS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS
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 1316
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0044
Mailing Address - Country:US
Mailing Address - Phone:541-482-2780
Mailing Address - Fax:541-482-2780
Practice Address - Street 1:850 SISKIYOU BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2125
Practice Address - Country:US
Practice Address - Phone:541-482-2780
Practice Address - Fax:541-482-2780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health