Provider Demographics
NPI:1841527371
Name:MILLER, EDNA
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92619
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-2619
Mailing Address - Country:US
Mailing Address - Phone:310-628-9512
Mailing Address - Fax:562-683-0386
Practice Address - Street 1:1984 OBISPO AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1234
Practice Address - Country:US
Practice Address - Phone:310-628-9512
Practice Address - Fax:562-683-0386
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-097544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional