Healthcare Provider Details

I. General information

NPI: 1962495556
Provider Name (Legal Business Name): MILLER GARRISON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROCKY GARRISON PH.D.

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 NE 45TH AVE
PORTLAND OR
97213-1342
US

IV. Provider business mailing address

2104 NE 45TH AVE
PORTLAND OR
97213-1342
US

V. Phone/Fax

Practice location:
  • Phone: 503-317-4521
  • Fax:
Mailing address:
  • Phone: 503-317-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number503
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: