Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YM0800X | Mental Health Counselor | MH15909 | FL |
NPI | 1003192451 |
---|---|
Provider Name | Mr. Joseph Martin Miller |
First Address | Port Salerno, FL 34992-0784 |
Second Address | Stuart, FL 34994-4531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 27/10/2020 |