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NPI Code Detail

MEDICARE: JOHNNY EARL MILLER SR.

MEDICARE:   JOHNNY EARL MILLER SR.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1831463900
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY EARL MILLER SR.
Provider Business Mailing Address
First Line : PO BOX 1248
Second Line :
City : WOODLAND
State : CA
Zip : 95776-1248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 207 4TH ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-3501
Country : US
Telephone Number : 530-661-1218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2012
Last Update Date : 03/06/2012

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Directions to “ JOHNNY EARL MILLER SR. ” Practice Location

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