Provider Demographics
NPI:1912187915
Name:MILLER, LORI LYNN (MS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:MILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT44925
Mailing Address - Street 1:501 ATKINS ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2501
Mailing Address - Country:US
Mailing Address - Phone:606-080-8727
Mailing Address - Fax:
Practice Address - Street 1:501 ATKINS ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2501
Practice Address - Country:US
Practice Address - Phone:760-608-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT44925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist