Provider Demographics
NPI:1104963065
Name:MILLER, JAMES GALEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GALEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16365 S ABIQUA RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9122
Mailing Address - Country:US
Mailing Address - Phone:503-873-4717
Mailing Address - Fax:
Practice Address - Street 1:565 UNION ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2477
Practice Address - Country:US
Practice Address - Phone:503-370-8050
Practice Address - Fax:503-370-9982
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
ORT0117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist