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General NPI Number Information
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NPI Number | 1710793823
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Entity Type | Individual
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Provider Name | WILLIAM BLAKE MILLER
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 5801 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-5641
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Country | US
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Telephone | 941-215-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 5331 CALLE FLORIDA
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City | SARASOTA
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State | FL
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Zip | 34242-1953
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Country | US
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Telephone | 941-217-9483
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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 | IMH24739
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License Number State | FL
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