Provider Demographics
NPI:1962547844
Name:MILLER, THOMAS NELSON
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:NELSON
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29364 BIRDY CT
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9493
Mailing Address - Country:US
Mailing Address - Phone:951-275-8722
Mailing Address - Fax:951-275-0725
Practice Address - Street 1:3768 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3621
Practice Address - Country:US
Practice Address - Phone:951-275-8722
Practice Address - Fax:951-275-0725
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)