Provider Demographics
NPI:1871500603
Name:MILLER, BEVERLY JEAN (LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 STATE ROUTE 364
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9754
Mailing Address - Country:US
Mailing Address - Phone:585-554-3562
Mailing Address - Fax:
Practice Address - Street 1:4610 BLUEBIRD RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9735
Practice Address - Country:US
Practice Address - Phone:585-396-0590
Practice Address - Fax:585-393-9477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health