Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301010641 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301010641 | MI |
NPI | 1003946831 |
---|---|
Provider Name | Lavina Jo Miller |
First Address | Howell, MI 48843-8503 |
Second Address | Howell, MI 48843-8542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |