Provider Demographics
NPI:1649086695
Name:MILLER, JERALDEEN CRAWFORD (APCC)
Entity type:Individual
Prefix:
First Name:JERALDEEN
Middle Name:CRAWFORD
Last Name:MILLER
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 E STETSON LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-1914
Mailing Address - Country:US
Mailing Address - Phone:515-351-8899
Mailing Address - Fax:
Practice Address - Street 1:4728 E STETSON LN
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-1914
Practice Address - Country:US
Practice Address - Phone:515-351-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC18145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health