Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 20010282A | IN |
N | 103T00000X | Psychologist | 20010282A | IN |
N | 102L00000X | Psychologist | 20010382A | IN |
N | 103T00000X | Psychologist | 20010382A | IN |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 20010382A | IN |
N | 103TA0700X | Adult Development & Aging Psychologist | 20010382A | IN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 20010382A | IN |
N | 103G00000X | Clinical Psychologist | 20010382A | IN |
N | 103TC0700X | Clinical Psychologist | 20010382A | IN |
N | 103TF0000X | Family Psychologist | 20010382A | IN |
N | 103TH0100X | Health Service | 20010382A | IN |
N | 103TP2701X | Group Psychotherapist | 20010382A | IN |
N | 103TR0400X | Rehabilitation Psychologist | 20010382A | IN |
NPI | 1376565796 |
---|---|
Provider Name | Dr. Theodore Robert Miller |
First Address | Alexandria, IN 46001-8830 |
Second Address | Marion, IN 46953-4568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |