Provider Demographics
NPI:1316187909
Name:SANDY MILLER, PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:SANDY MILLER, PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW
Authorized Official - Phone:734-709-1232
Mailing Address - Street 1:1139 WENDY CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3175
Mailing Address - Country:US
Mailing Address - Phone:734-709-1232
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:734-709-1232
Practice Address - Fax:734-998-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010772621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty