Provider Demographics
NPI:1306235965
Name:MILLER, VICTORIA L (BCBA)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7203 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7967
Mailing Address - Country:US
Mailing Address - Phone:317-544-6000
Mailing Address - Fax:
Practice Address - Street 1:7203 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7967
Practice Address - Country:US
Practice Address - Phone:317-544-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-17564103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-17564OtherBEHAVIOR ANALYST CERTIFICATION BOARD
1-14-17564OtherBCBA CERTIFICATE