Healthcare Provider Details

I. General information

NPI: 1245051937
Provider Name (Legal Business Name): ROBERT JAXSON MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 3RD AVE HUNTINGTON WV 25755
HUNTINGTON WV
25755-0001
US

IV. Provider business mailing address

1745 3RD AVE HUNTINGTON WV 25755
HUNTINGTON WV
25755-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-2772
  • Fax:
Mailing address:
  • Phone: 304-696-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: