Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | RPS2009026 | CA |
NPI | 1013101351 |
---|---|
Provider Name | Chantelle La Treice Miller |
First Address | Los Angeles, CA 90057-4303 |
Second Address | Los Angeles, CA 90043-4532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 14/04/2011 |