Healthcare Provider Details

I. General information

NPI: 1386741460
Provider Name (Legal Business Name): MICHAEL LEWIS MILLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 NE 55TH ST STE B
SEATTLE WA
98105-2254
US

IV. Provider business mailing address

4026 NE 55TH ST STE B
SEATTLE WA
98105-2254
US

V. Phone/Fax

Practice location:
  • Phone: 206-526-5511
  • Fax: 206-526-5512
Mailing address:
  • Phone: 206-526-5511
  • Fax: 206-526-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00000548
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPY00000548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: