Provider Demographics
NPI:1114773140
Name:MILLER, BRYANA (LPC)
Entity type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:MILLER
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CROGHAN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2337
Mailing Address - Country:US
Mailing Address - Phone:419-458-3100
Mailing Address - Fax:567-250-2152
Practice Address - Street 1:915 CROGHAN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2337
Practice Address - Country:US
Practice Address - Phone:419-458-3100
Practice Address - Fax:567-250-2152
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2405745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health