Healthcare Provider Details

I. General information

NPI: 1619633096
Provider Name (Legal Business Name): SHAYLYN MILLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5694 MISSION CENTER RD. STE.602 PMB. 475
SAN DIEGO CA
92108
US

IV. Provider business mailing address

5694 MISSION CENTER RD. STE.602 PMB. 475
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-6170
  • Fax:
Mailing address:
  • Phone: 619-800-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: