Healthcare Provider Details

I. General information

NPI: 1538682364
Provider Name (Legal Business Name): MATTHEW MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E BRIDGE ST
BREAUX BRIDGE LA
70517-3804
US

IV. Provider business mailing address

730 E BRIDGE ST
BREAUX BRIDGE LA
70517-3804
US

V. Phone/Fax

Practice location:
  • Phone: 337-447-3989
  • Fax:
Mailing address:
  • Phone: 337-447-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5117
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: