MEDICARE: DR. NANCY MILLER PHD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	CA
2	101YP2500X	Professional Counselor	CA
3	103TC1900X	Counseling Psychologist	CA
4	101YP1600X	Pastoral Counselor	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346372281	OTHER	CA	BLUE SHIELD,

General Provider Information

NPI Number	:	1346372281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY MILLER PHD

Provider Business Mailing Address
First Line	:	1450 W 7TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-3516
Country	:	US
Telephone Number	:	310-832-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 W 7TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-3516
Country	:	US
Telephone Number	:	310-832-3140
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	10/31/2016

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