Healthcare Provider Details

I. General information

NPI: 1336115492
Provider Name (Legal Business Name): SUSAN RAE MILLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 05/16/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 RANCHO BERNARDO RD STE 380
SAN DIEGO CA
92127-5724
US

IV. Provider business mailing address

10815 RANCHO BERNARDO RD STE 380
SAN DIEGO CA
92127-5724
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax: 858-467-7161
Mailing address:
  • Phone: 858-279-1223
  • Fax: 858-467-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number24561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: