Healthcare Provider Details

I. General information

NPI: 1376565796
Provider Name (Legal Business Name): THEODORE ROBERT MILLER PH.D., HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

11605 N 100 E
ALEXANDRIA IN
46001-8830
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax: 765-677-5122
Mailing address:
  • Phone: 765-724-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010282A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number20010382A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number20010382A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20010382A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010382A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20010382A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20010382A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010382A
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20010382A
License Number StateIN
# 10
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number20010382A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: