Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | CA | |
N | 101YP1600X | Pastoral Counselor | CA | |
Y | 101YP2500X | Professional Counselor | CA | |
N | 103TC1900X | Counseling Psychologist | CA |
NPI | 1346372281 |
---|---|
Provider Name | Dr. Nancy Miller |
First Address | San Pedro, CA 90732-3516 |
Second Address | San Pedro, CA 90732-3516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 31/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346372281 | BLUE SHIELD, (01) | CA |