Provider Demographics
NPI:1336890805
Name:MILLER, JULIA MAE (PPS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MAE
Other - Last Name:EASLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34133 DIANTHUS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2981
Mailing Address - Country:US
Mailing Address - Phone:661-583-2493
Mailing Address - Fax:
Practice Address - Street 1:34133 DIANTHUS LN
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2981
Practice Address - Country:US
Practice Address - Phone:661-583-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool