Basic Information
| Provider Information | |||||||||
| NPI: | 1205389004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | CHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20217 13TH AVENUE CT E | ||||||||
| Address2: | |||||||||
| City: | SPANAWAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983878084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532838188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3214 W MCGRAW ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981993239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2016 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 60677808 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | CG60677808 | 01 | WA | AGENCY AFFILIATED COUNSELOR | OTHER |