Provider Demographics
NPI:1285102889
Name:MILLER, PETER S
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1922
Mailing Address - Country:US
Mailing Address - Phone:513-221-3350
Mailing Address - Fax:513-221-3665
Practice Address - Street 1:2640 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3147
Practice Address - Country:US
Practice Address - Phone:937-586-0435
Practice Address - Fax:937-610-2795
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health