Provider Demographics
NPI:1982037958
Name:MILLER, ANNIE MAREE (LMFT)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:MAREE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 N ROSEMEAD BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3053
Mailing Address - Country:US
Mailing Address - Phone:626-802-5492
Mailing Address - Fax:626-325-9349
Practice Address - Street 1:482 N ROSEMEAD BLVD STE 207
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3053
Practice Address - Country:US
Practice Address - Phone:626-802-5492
Practice Address - Fax:626-325-9349
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912211871OtherGROUP NPI
ZZZ70107YOtherBLUE SHIELD OF CALIFORNIA
1912211871OtherGROUP NPI