Provider Demographics
NPI:1689721441
Name:MILLER, DONALD J (MALLP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 LANE BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3894
Mailing Address - Country:US
Mailing Address - Phone:269-349-5084
Mailing Address - Fax:
Practice Address - Street 1:112 E CHART ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1768
Practice Address - Country:US
Practice Address - Phone:269-685-6363
Practice Address - Fax:269-685-9559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007500103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling