Provider Demographics
NPI:1912004169
Name:MILLER, DUDLEY BYRON (MDIV)
Entity Type:Individual
Prefix:MR
First Name:DUDLEY
Middle Name:BYRON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 114TH AVE SE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6903
Mailing Address - Country:US
Mailing Address - Phone:206-898-9029
Mailing Address - Fax:425-462-2966
Practice Address - Street 1:1309 114TH AVE SE
Practice Address - Street 2:SUITE 316
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6903
Practice Address - Country:US
Practice Address - Phone:206-898-9029
Practice Address - Fax:425-462-2966
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00000819101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor