MEDICARE: LORI MILLER MFT

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	43489	CA

General Provider Information

NPI Number	:	1861521486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MILLER MFT

Provider Business Mailing Address
First Line	:	4225H OCEANSIDE BLVD # 220
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-3471
Country	:	US
Telephone Number	:	760-472-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 UNIVERSITY AVE STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6540
Country	:	US
Telephone Number	:	858-277-9550
Fax Number	:	858-279-2763

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	12/14/2020

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