Provider Demographics
NPI:1831300698
Name:MILLER, KEITH A (LMSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36400 WOODWARD AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0904
Mailing Address - Country:US
Mailing Address - Phone:248-709-4588
Mailing Address - Fax:
Practice Address - Street 1:36400 WOODWARD AVE STE 125
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0904
Practice Address - Country:US
Practice Address - Phone:248-709-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010887541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical