Healthcare Provider Details

I. General information

NPI: 1871753616
Provider Name (Legal Business Name): ANNETTE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W VICTORIA ST
LONG BEACH CA
90805-2175
US

IV. Provider business mailing address

21114 PIONEER BLVD APT 216
LAKEWOOD CA
90715-2157
US

V. Phone/Fax

Practice location:
  • Phone: 310-603-1030
  • Fax: 310-603-1377
Mailing address:
  • Phone: 310-603-1030
  • Fax: 310-603-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: