Provider Demographics
NPI:1972890549
Name:MILLER, MEGAN AMANDA (LMHC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:AMANDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2005
Mailing Address - Country:US
Mailing Address - Phone:415-924-5995
Mailing Address - Fax:
Practice Address - Street 1:1251 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2005
Practice Address - Country:US
Practice Address - Phone:415-924-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0139801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health