1871500603 NPI number — MRS. BEVERLY JEAN MILLER LMHC, NCC

Table of content: MRS. BEVERLY JEAN MILLER LMHC, NCC (NPI 1871500603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871500603 NPI number — MRS. BEVERLY JEAN MILLER LMHC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
BEVERLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871500603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4633 STATE ROUTE 364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANANDAIGUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14424-9754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-554-3562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 BLUEBIRD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANANDAIGUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14424-9735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-396-0590
Provider Business Practice Location Address Fax Number:
585-393-9477
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  000179 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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