Provider Demographics
NPI:1669552899
Name:MILLER, SHELLEY (MS, IMFT)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2409
Mailing Address - Country:US
Mailing Address - Phone:937-454-0092
Mailing Address - Fax:937-264-1101
Practice Address - Street 1:3821 LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2409
Practice Address - Country:US
Practice Address - Phone:937-454-0092
Practice Address - Fax:937-264-1101
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0000088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF0000088OtherLICENSE NUMBER