Provider Demographics
NPI:1295517621
Name:MLMPSYCH CORP
Entity type:Organization
Organization Name:MLMPSYCH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNP
Authorized Official - Phone:937-563-4901
Mailing Address - Street 1:1533 MOOREFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5742
Mailing Address - Country:US
Mailing Address - Phone:937-463-4901
Mailing Address - Fax:937-381-6975
Practice Address - Street 1:1533 MOOREFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5742
Practice Address - Country:US
Practice Address - Phone:937-563-4901
Practice Address - Fax:937-381-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty