=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982037958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNIE MAREE MILLER LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2013
-----------------------------------------------------
Last Update Date | 08/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 482 N ROSEMEAD BLVD STE 207
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-802-5492
-----------------------------------------------------
Fax | 626-325-9349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 482 N ROSEMEAD BLVD STE 207
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-802-5492
-----------------------------------------------------
Fax | 626-325-9349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC52595
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------