Provider Demographics
NPI:1396081287
Name:MILLER, ASHLEY C (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 VISTABULA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5424
Mailing Address - Country:US
Mailing Address - Phone:770-557-8137
Mailing Address - Fax:
Practice Address - Street 1:745 VISTABULA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5424
Practice Address - Country:US
Practice Address - Phone:770-557-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst