Provider Demographics
NPI:1811164874
Name:MILLER, MARY (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SW SHEVLIN HIXON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3189
Mailing Address - Country:US
Mailing Address - Phone:541-617-0337
Mailing Address - Fax:541-617-5944
Practice Address - Street 1:143 SW SHEVLIN HIXON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3189
Practice Address - Country:US
Practice Address - Phone:541-617-0337
Practice Address - Fax:541-617-5944
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health