Provider Demographics
NPI:1821162322
Name:MILLER, CAROL LEE (SPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:CA
Mailing Address - Zip Code:95914
Mailing Address - Country:US
Mailing Address - Phone:530-679-0862
Mailing Address - Fax:
Practice Address - Street 1:18 COUNTY CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:530-538-2161
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23308167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT23308OtherPSYCHIATRIC TECHNICIAN