Provider Demographics
NPI:1982353066
Name:MILLER, JAMES ERVIN (MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERVIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 WILLIAM AVE W
Mailing Address - Street 2:
Mailing Address - City:DASSEL
Mailing Address - State:MN
Mailing Address - Zip Code:55325-1128
Mailing Address - Country:US
Mailing Address - Phone:161-279-9516
Mailing Address - Fax:
Practice Address - Street 1:121 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2514
Practice Address - Country:US
Practice Address - Phone:855-454-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPENDING106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist