Provider Demographics
NPI:1063232544
Name:MILLER, NATHAN RANDALL (MACP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:RANDALL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 W SHERWIN AVE APT GW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5768
Mailing Address - Country:US
Mailing Address - Phone:312-550-9453
Mailing Address - Fax:
Practice Address - Street 1:5150 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1283
Practice Address - Country:US
Practice Address - Phone:847-745-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional