Provider Demographics
NPI:1063515070
Name:MILLER-GIVAN, SANDRA GALE (MA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GALE
Last Name:MILLER-GIVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 PATRICK PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2213
Mailing Address - Country:US
Mailing Address - Phone:317-858-8630
Mailing Address - Fax:317-858-8715
Practice Address - Street 1:640 PATRICK PL
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2213
Practice Address - Country:US
Practice Address - Phone:317-858-8630
Practice Address - Fax:317-858-8715
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000160A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist