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General NPI Number Information
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NPI Number | 1528694643
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL MILLER LSW, LICDC-S
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1441 PHALE D. HALE DR.
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City | COLUMBUS
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State | OH
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Zip | 43203
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Country | US
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Telephone | 614-257-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 11122 GORSUCH RD
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City | GALENA
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State | OH
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Zip | 43021-9633
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Country | US
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Telephone | 419-203-9314
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 001104
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License Number State | OH
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