Provider Demographics
NPI:1639262827
Name:MILLER, JULIANN V (MA LP)
Entity type:Individual
Prefix:
First Name:JULIANN
Middle Name:V
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16136 INVERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4620
Mailing Address - Country:US
Mailing Address - Phone:952-891-3387
Mailing Address - Fax:
Practice Address - Street 1:6800 FRANCE AVE S STE 560
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2019
Practice Address - Country:US
Practice Address - Phone:952-929-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist