Provider Demographics
NPI:1427171388
Name:MILLER, WILEY (PHD)
Entity type:Individual
Prefix:DR
First Name:WILEY
Middle Name:
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:PO BOX 7382
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7382
Mailing Address - Country:US
Mailing Address - Phone:573-864-8574
Mailing Address - Fax:
Practice Address - Street 1:300 SAINT JAMES ST
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5160
Practice Address - Country:US
Practice Address - Phone:573-864-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist