Provider Demographics
NPI:1871685479
Name:MILLER, MERIDITH LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:MERIDITH
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3738
Mailing Address - Country:US
Mailing Address - Phone:248-608-6800
Mailing Address - Fax:248-650-1856
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-608-6800
Practice Address - Fax:248-650-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF 33675 4681Medicare ID - Type Unspecified
MIR66894Medicare UPIN