Provider Demographics
NPI:1275339566
Name:MILLER, CRYSTAL LEEANN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEEANN
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-2601
Mailing Address - Country:US
Mailing Address - Phone:740-441-9800
Mailing Address - Fax:
Practice Address - Street 1:1336 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-2601
Practice Address - Country:US
Practice Address - Phone:740-441-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator