Provider Demographics
NPI:1184789430
Name:MILLER, DANIEL LLOYD (MA LMFT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LLOYD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:207 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309
Practice Address - Country:US
Practice Address - Phone:763-367-6080
Practice Address - Fax:763-263-7897
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-26715OtherMEDICA ID NUMBER
MN104M9MIOtherBCBS ID NUMBER
MNHP41030OtherHEALTH PARTNERS ID NUMBER
MN974688900Medicaid