Provider Demographics
NPI:1932387768
Name:MILLER, JEANINE COURTNEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:COURTNEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 MONROE XING
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3159
Mailing Address - Country:US
Mailing Address - Phone:615-578-8471
Mailing Address - Fax:
Practice Address - Street 1:103 CONTINENTAL PL STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1086
Practice Address - Country:US
Practice Address - Phone:615-462-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical