Provider Demographics
NPI:1649741414
Name:MILLER, MOSHE YOSAIF
Entity Type:Individual
Prefix:MR
First Name:MOSHE
Middle Name:YOSAIF
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MO
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:106 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1533
Mailing Address - Country:US
Mailing Address - Phone:847-549-2235
Mailing Address - Fax:
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1533
Practice Address - Country:US
Practice Address - Phone:847-549-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor