Provider Demographics
NPI:1598125239
Name:MILLER, MICHAEL J (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA
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 18354
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-8354
Mailing Address - Country:US
Mailing Address - Phone:657-272-0713
Mailing Address - Fax:
Practice Address - Street 1:501 N BROOKHURST ST STE 306
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5204
Practice Address - Country:US
Practice Address - Phone:657-272-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional