Provider Demographics
NPI:1285933705
Name:MILLER, CARRIE ELLEN (PHD)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:ELLEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W. ALAMEDA AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4048
Mailing Address - Country:US
Mailing Address - Phone:213-608-5631
Mailing Address - Fax:
Practice Address - Street 1:4001 W. ALAMEDA AVE
Practice Address - Street 2:STE 205
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4048
Practice Address - Country:US
Practice Address - Phone:213-608-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical