Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073912754 |
---|---|
Provider Name | Mrs. Latoyia Tennelle Miller |
First Address | Wellington, FL 33414-5543 |
Second Address | Wellington, FL 33414-5543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 19/08/2014 |