Healthcare Provider Details

I. General information

NPI: 1841771888
Provider Name (Legal Business Name): DELANY MILLER AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 AVENUE 64
PASADENA CA
91105-2711
US

IV. Provider business mailing address

815 COLORADO BLVD STE 300
LOS ANGELES CA
90041-1744
US

V. Phone/Fax

Practice location:
  • Phone: 323-255-0978
  • Fax:
Mailing address:
  • Phone: 323-543-2800
  • Fax: 323-978-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT113981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: