Healthcare Provider Details

I. General information

NPI: 1184665390
Provider Name (Legal Business Name): MARK LYNN MILLER PSY.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST #17701
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

3452 46TH AVE S
MINNEAPOLIS MN
55406-2931
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-5327
  • Fax: 612-863-2596
Mailing address:
  • Phone: 612-722-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2306
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2306
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP2306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: