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General NPI Number Information
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NPI Number | 1679554497
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Entity Type | Organization
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Legal Business Name | CEDAR RIVER COUNSELING & EDUCATIONAL SERVICES, INC.
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 1403 15TH AVE NW
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City | AUSTIN
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State | MN
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Zip | 55912-1911
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Country | US
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Telephone | 507-433-6482
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Fax | 507-433-0097
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Provider Business Mailing Address
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Address Line | 1403 15TH AVE NW
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City | AUSTIN
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State | MN
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Zip | 55912-1911
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Country | US
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Telephone | 507-433-6482
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Fax | 507-433-0097
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Authorized Official
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Title or Position | DIRECTOR/PSYCHOLOGIST
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Name | DR. STANLEY R MILLER
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Credential | PSY.D.,L.P.
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Telephone | 507-433-6482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3235
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License Number State | MN
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