Provider Demographics
NPI:1700364734
Name:MILLER, TYRONE PERRY SR (MA, CCFC, CCHP-MH)
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:PERRY
Last Name:MILLER
Suffix:SR
Gender:M
Credentials:MA, CCFC, CCHP-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9276
Mailing Address - Country:US
Mailing Address - Phone:209-810-3393
Mailing Address - Fax:
Practice Address - Street 1:22320 FOOTHILL BLVD STE 428
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2719
Practice Address - Country:US
Practice Address - Phone:510-722-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic