Provider Demographics
NPI:1427124916
Name:MILLER, SUSAN FITZPATRICK (MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FITZPATRICK
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 E FLAMINGO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7483
Mailing Address - Country:US
Mailing Address - Phone:702-486-7511
Mailing Address - Fax:702-486-7576
Practice Address - Street 1:3075 E FLAMINGO RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7483
Practice Address - Country:US
Practice Address - Phone:702-486-7511
Practice Address - Fax:702-486-7576
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health