Healthcare Provider Details

I. General information

NPI: 1063283406
Provider Name (Legal Business Name): CHRISTIAN MICHAEL MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E 10TH ST
JEFFERSONVILLE IN
47130-6000
US

IV. Provider business mailing address

3017 AUTUMN HILL TRL
NEW ALBANY IN
47150-9463
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8248
  • Fax:
Mailing address:
  • Phone: 812-525-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: