Provider Demographics
NPI:1750712493
Name:MILLER, JAMES J III (CADC I)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:MILLER
Suffix:III
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NW HAWTHORNE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2929
Mailing Address - Country:US
Mailing Address - Phone:541-306-4446
Mailing Address - Fax:541-550-2011
Practice Address - Street 1:131 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2929
Practice Address - Country:US
Practice Address - Phone:541-306-4446
Practice Address - Fax:541-550-2011
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-09-32101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)