Provider Demographics
NPI:1649565169
Name:MILLER, CHERYL S (EDUCATIONAL PSYCHOLO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:EDUCATIONAL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29170 HEATHERCLIFF RD STE B
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4100
Mailing Address - Country:US
Mailing Address - Phone:818-661-8892
Mailing Address - Fax:
Practice Address - Street 1:29170 HEATHERCLIFF RD STE B
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4100
Practice Address - Country:US
Practice Address - Phone:818-661-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP1765103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool