Healthcare Provider Details

I. General information

NPI: 1336004076
Provider Name (Legal Business Name): MATTIE CHRISTINE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 3RD ST
SAINT HELENS OR
97051-2009
US

IV. Provider business mailing address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

V. Phone/Fax

Practice location:
  • Phone: 971-203-0158
  • Fax: 503-397-6818
Mailing address:
  • Phone: 971-203-0158
  • Fax: 503-397-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: