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General NPI Number Information
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NPI Number | 1912581521
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Entity Type | Individual
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Provider Name | TINA MILLER
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 31700 W 12 MILE RD STE 100&250
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-4424
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Country | US
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Telephone | 586-321-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 172 COTTAGE DR
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City | HORTON
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State | MI
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Zip | 49246-9727
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Country | US
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Telephone | 586-321-6179
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009261
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License Number State | MI
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