Provider Demographics
NPI:1720696016
Name:MILLER, STEVEN ROY (MLC , MH, MNLP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MLC , MH, MNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 RUCKER AVE # 2D
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2772
Mailing Address - Country:US
Mailing Address - Phone:425-971-7473
Mailing Address - Fax:
Practice Address - Street 1:2230 RUCKER AVE # 2D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2772
Practice Address - Country:US
Practice Address - Phone:425-971-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA6017076031744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder