Healthcare Provider Details

I. General information

NPI: 1619424041
Provider Name (Legal Business Name): VINCENT MICHAEL MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GRANDVIEW DR
BISHOP CA
93514-2984
US

IV. Provider business mailing address

166 GRANDVIEW DR
BISHOP CA
93514-2984
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-3262
  • Fax: 760-873-3324
Mailing address:
  • Phone: 760-873-3262
  • Fax: 760-873-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: