Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301012895 | MI |
NPI | 1043251796 |
---|---|
Provider Name | Dr. Matthew Alan Miller |
First Address | Lansing, MI 48911-4275 |
Second Address | Lansing, MI 48911-4275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |