Healthcare Provider Details

I. General information

NPI: 1497931075
Provider Name (Legal Business Name): KRISTI MICHELLE GITTNER MILLER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W PENNSYLVANIA AVE
DELAND FL
32720-3429
US

IV. Provider business mailing address

386 S ATLANTIC AVE # 208
ORMOND BEACH FL
32176-7143
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-1618
  • Fax:
Mailing address:
  • Phone: 386-258-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: