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General NPI Number Information
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NPI Number | 1558878769
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Entity Type | Individual
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Provider Name | ROBERT CORY MILLER B.ED.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 300 JERRYS DR
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City | ROSEBURG
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State | OR
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Zip | 97470-1132
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Country | US
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Telephone | 541-673-4354
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Fax |
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Provider Business Mailing Address
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Address Line | 150 NE BROSI ORCHARD RD
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City | WINSTON
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State | OR
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Zip | 97496-5522
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Country | US
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Telephone | 541-621-6297
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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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