Provider Demographics
NPI:1851642581
Name:MILLER, SHIRLEY ANNE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 HAMPSHIRE RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2810
Mailing Address - Country:US
Mailing Address - Phone:805-660-7743
Mailing Address - Fax:
Practice Address - Street 1:870 HAMPSHIRE RD
Practice Address - Street 2:SUITE P
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2810
Practice Address - Country:US
Practice Address - Phone:805-660-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-4614516OtherEMPLOYER IDENTIFICATION NUMBER