Provider Demographics
NPI:1720166424
Name:MILLER, DANIEL (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 CARROLLTON RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3944
Mailing Address - Country:US
Mailing Address - Phone:989-755-0605
Mailing Address - Fax:989-755-0605
Practice Address - Street 1:3564 CARROLLTON RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3944
Practice Address - Country:US
Practice Address - Phone:989-755-0605
Practice Address - Fax:989-755-0605
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009486103T00000X
MI6801058819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1016814OtherMCLAREN
MI730195Medicaid
MI0995594OtherHEALTHPLUS