Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 25703 | CA |
N | 103TC0700X | Clinical Psychologist | 25703 | CA |
Y | 103G00000X | Clinical Psychologist | 701 | NV |
Y | 103TC0700X | Clinical Psychologist | 701 | NV |
NPI | 1003162314 |
---|---|
Provider Name | Dr. Justin Benjamin Miller |
First Address | Las Vegas, NV 89106-0100 |
Second Address | Las Vegas, NV 89106-0100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 30/03/2015 |