Healthcare Provider Details

I. General information

NPI: 1649744095
Provider Name (Legal Business Name): MARK MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12955 BISCAYNE BLVD STE 200
NORTH MIAMI FL
33181-2021
US

IV. Provider business mailing address

12955 BISCAYNE BLVD STE 200
NORTH MIAMI FL
33181-2021
US

V. Phone/Fax

Practice location:
  • Phone: 727-732-3369
  • Fax:
Mailing address:
  • Phone: 727-732-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: