MEDICARE: DR. BOBBI JEAN MILLER PH.D.

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
1	106H00000X	Marriage & Family Therapist	200836	TX
2	106H00000X	Marriage & Family Therapist	2008034250	MO

General Provider Information

NPI Number	:	1467662338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBI JEAN MILLER PH.D.

Provider Business Mailing Address
First Line	:	801 WOODLAWN AVENUE
Second Line	:	SUITE 29
City	:	O'FALLON
State	:	MO
Zip	:	63366
Country	:	US
Telephone Number	:	636-379-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S WOODLAWN
Second Line	:	SUITE 29
City	:	O FALLON
State	:	MO
Zip	:	63366-7646
Country	:	US
Telephone Number	:	636-379-1779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/28/2011

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