Healthcare Provider Details

I. General information

NPI: 1699685263
Provider Name (Legal Business Name): BRANDON MILLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 32ND AVE W
WEST FARGO ND
58078-8565
US

IV. Provider business mailing address

779 32ND AVE W
WEST FARGO ND
58078-8565
US

V. Phone/Fax

Practice location:
  • Phone: 701-639-2739
  • Fax: 701-299-4510
Mailing address:
  • Phone: 701-639-2739
  • Fax: 701-299-4510

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: