Provider Demographics
NPI:1922058882
Name:MILLER, ELLEN WINTERS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:WINTERS
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LUCERNE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6819
Mailing Address - Country:US
Mailing Address - Phone:949-307-6208
Mailing Address - Fax:949-307-8635
Practice Address - Street 1:150 PAULARINO AVE
Practice Address - Street 2:BUILDING D, SUITE 185
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3301
Practice Address - Country:US
Practice Address - Phone:949-307-6208
Practice Address - Fax:949-307-8635
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist