Healthcare Provider Details

I. General information

NPI: 1033327473
Provider Name (Legal Business Name): DAVID JOEL MILLER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 WILLOW AVE SUITE 103
CLOVIS CA
93612-4747
US

IV. Provider business mailing address

3134 WILLOW AVE SUITE 103
CLOVIS CA
93612-4747
US

V. Phone/Fax

Practice location:
  • Phone: 559-977-0614
  • Fax: 559-453-5700
Mailing address:
  • Phone: 559-977-0614
  • Fax: 559-453-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC45390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: