Provider Demographics
NPI:1891954665
Name:MILLER, RACHEL MAE (MA, BCBA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, BCBA, LLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E FIRMIN STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2375
Mailing Address - Country:US
Mailing Address - Phone:765-454-9748
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:1300 AIRPORT NORTH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6716
Practice Address - Country:US
Practice Address - Phone:260-471-9263
Practice Address - Fax:260-471-9264
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013451103T00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-05-2440OtherBCBA CERTIFICATE