Provider Demographics
NPI:1871035923
Name:MILLER, LANDON
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-9754
Mailing Address - Country:US
Mailing Address - Phone:717-656-6580
Mailing Address - Fax:717-656-3056
Practice Address - Street 1:1417 OREGON RD
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-9754
Practice Address - Country:US
Practice Address - Phone:717-656-6580
Practice Address - Fax:717-656-3056
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional