MEDICARE: NIKKI M MILLER MFCT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI21678	CA

General Provider Information

NPI Number	:	1225240815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI M MILLER MFCT

Provider Business Mailing Address
First Line	:	28081 SMYTH DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4023
Country	:	US
Telephone Number	:	661-257-1922
Fax Number	:	661-702-8415

Provider Business Practice Location Address
First Line	:	28081 SMYTH DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4023
Country	:	US
Telephone Number	:	661-257-1922
Fax Number	:	661-702-8415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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