Healthcare Provider Details

I. General information

NPI: 1386573459
Provider Name (Legal Business Name): ANGELA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TOMMY HENRICH DR NW
MASSILLON OH
44647-5402
US

IV. Provider business mailing address

1717 CALIFORNIA AVE
LOUISVILLE OH
44641-9013
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-9582
  • Fax: 330-775-7463
Mailing address:
  • Phone: 330-417-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: