Provider Demographics
NPI:1689000622
Name:MILLER, CLEO
Entity Type:Individual
Prefix:
First Name:CLEO
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E TROPICANA AVE STE 137
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6552
Mailing Address - Country:US
Mailing Address - Phone:702-530-2788
Mailing Address - Fax:702-430-2659
Practice Address - Street 1:1516 E TROPICANA AVE STE 137
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6552
Practice Address - Country:US
Practice Address - Phone:702-530-2788
Practice Address - Fax:702-430-2659
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst