Provider Demographics
NPI:1962495556
Name:GARRISON, MILLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILLER
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ROCKY
Other - Middle Name:
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2104 NE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1342
Mailing Address - Country:US
Mailing Address - Phone:503-317-4521
Mailing Address - Fax:
Practice Address - Street 1:2104 NE 45TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1342
Practice Address - Country:US
Practice Address - Phone:503-317-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR503103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily