Provider Demographics
NPI:1386741460
Name:MILLER, MICHAEL LEWIS (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 NE 55TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2254
Mailing Address - Country:US
Mailing Address - Phone:206-526-5511
Mailing Address - Fax:206-526-5512
Practice Address - Street 1:4026 NE 55TH ST STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2254
Practice Address - Country:US
Practice Address - Phone:206-526-5511
Practice Address - Fax:206-526-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000548103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis