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NPI Code Detail

MEDICARE: MILLER GOAN

MEDICARE: MILLER GOAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1199TN

General Provider Information

NPI Number : 1023634839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLER GOAN
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 629-216-2007
Fax Number :
Provider Business Practice Location Address
First Line : 883 SEVEN OAKS BLVD STE 850
Second Line :
City : SMYRNA
State : TN
Zip : 37167-6691
Country : US
Telephone Number : 629-216-2007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2020
Last Update Date : 11/07/2023

Similar Medicare Providers

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1528662574 — TIANA MOORER
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1972193027 — CALEIGH EDLER MA, LBA, BCBA
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1588241855 — EMILY ANNE BELL
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Directions to “ MILLER GOAN ” Practice Location

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