Provider Demographics
NPI:1649280017
Name:MILLER, BYRON H (MFT)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386-0193
Mailing Address - Country:US
Mailing Address - Phone:209-667-5683
Mailing Address - Fax:209-874-1437
Practice Address - Street 1:384 E OLIVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4051
Practice Address - Country:US
Practice Address - Phone:209-638-6673
Practice Address - Fax:209-874-1437
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist