Provider Demographics
NPI:1992088173
Name:MILLER, JOHN A (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
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 1:1081 GLORIA AVE
Mailing Address - Street 2:APT D
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2996
Mailing Address - Country:US
Mailing Address - Phone:312-961-4830
Mailing Address - Fax:
Practice Address - Street 1:1081 GLORIA AVE
Practice Address - Street 2:APT D
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2996
Practice Address - Country:US
Practice Address - Phone:312-961-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist