Healthcare Provider Details

I. General information

NPI: 1790647469
Provider Name (Legal Business Name): ALEXANDRA GRACE MILLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29398 RECOVERY WAY STE 2
JUNCTION CITY OR
97448-8447
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 541-998-4574
  • Fax: 541-998-4533
Mailing address:
  • Phone: 541-858-8170
  • Fax: 541-858-8167

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: