Provider Demographics
NPI:1982676813
Name:MILLER, MARY PRATT (LPC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PRATT
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 GRISWOLD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1690
Mailing Address - Country:US
Mailing Address - Phone:248-719-5103
Mailing Address - Fax:
Practice Address - Street 1:640 GRISWOLD ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1690
Practice Address - Country:US
Practice Address - Phone:248-719-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12470227OtherCAQH