Provider Demographics
NPI:1790855443
Name:MILLER, CINDY L (PHD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 BANCROFT
Mailing Address - Street 2:STE I
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-542-7365
Mailing Address - Fax:406-542-1032
Practice Address - Street 1:1805 BANCROFT
Practice Address - Street 2:STE I
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-542-7365
Practice Address - Fax:406-542-1032
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT52061OtherBLUE CROSS
MT0491317Medicaid
MT52061OtherBLUE CROSS