Provider Demographics
NPI:1770199556
Name:MILLER, ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S HOOVER BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3574
Mailing Address - Country:US
Mailing Address - Phone:317-443-8737
Mailing Address - Fax:
Practice Address - Street 1:205 S HOOVER BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3574
Practice Address - Country:US
Practice Address - Phone:813-563-1155
Practice Address - Fax:813-602-0216
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10914103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist