Healthcare Provider Details

I. General information

NPI: 1225320591
Provider Name (Legal Business Name): AMY RUTH MILLER ENGELHARD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RUTH MILLER LMFT

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLEARY LN
EAGAN MN
55123-2340
US

IV. Provider business mailing address

5455 SMETANA DRIVE APT. 1116
MINNETONKA MN
55343-9699
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-0114
  • Fax:
Mailing address:
  • Phone: 952-239-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2046
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: