Provider Demographics
NPI:1972789527
Name:MILLER, JOHN KENNETH (PHD, LMFT)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:KENNETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KINCAID ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3737
Mailing Address - Country:US
Mailing Address - Phone:541-338-4336
Mailing Address - Fax:
Practice Address - Street 1:1414 KINCAID ST
Practice Address - Street 2:SUITE 207
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3737
Practice Address - Country:US
Practice Address - Phone:541-338-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist