Healthcare Provider Details

I. General information

NPI: 1457936411
Provider Name (Legal Business Name): THE MILLER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23215 COMMERCE PARK STE 205
BEACHWOOD OH
44122-5803
US

IV. Provider business mailing address

23215 COMMERCE PARK STE 205
BEACHWOOD OH
44122-5803
US

V. Phone/Fax

Practice location:
  • Phone: 216-407-6278
  • Fax: 216-647-0613
Mailing address:
  • Phone: 164-076-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANN HULL KUSTER
Title or Position: PRESIDENT
Credential: LISW
Phone: 216-407-6278