Provider Demographics
NPI:1982916417
Name:MILLER, ROBERT B (EDD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:MILLER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 BERL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2801
Mailing Address - Country:US
Mailing Address - Phone:989-780-0174
Mailing Address - Fax:
Practice Address - Street 1:4905 BERL DR STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2801
Practice Address - Country:US
Practice Address - Phone:989-780-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010742103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist