Provider Demographics
NPI:1689691263
Name:MILLER, COLLEEN K (MFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11026 MONOGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5216
Mailing Address - Country:US
Mailing Address - Phone:818-363-6310
Mailing Address - Fax:818-366-3256
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:STE. 205
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:818-363-6310
Practice Address - Fax:818-366-3256
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist