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General NPI Number Information
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NPI Number | 1295351369
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Entity Type | Individual
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Provider Name | SHELBY MILLER
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Gender | Female
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 118 1/2 N WOODLAND BLVD
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City | DELAND
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State | FL
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Zip | 32720-4268
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Country | US
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Telephone | 386-968-2063
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 W CHURCH ST
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City | DELAND
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State | FL
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Zip | 32720-3902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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