Provider Demographics
NPI:1285145227
Name:MILLER, TONYA LATREASE (BA, CDPT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LATREASE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BA, CDPT
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:LATREASE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CDPT
Mailing Address - Street 1:24823 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5478
Mailing Address - Country:US
Mailing Address - Phone:253-681-0010
Mailing Address - Fax:253-680-0014
Practice Address - Street 1:24823 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5478
Practice Address - Country:US
Practice Address - Phone:253-681-0010
Practice Address - Fax:253-681-0014
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)