Basic Information
| Provider Information | |||||||||
| NPI: | 1538147855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNIC-MILLER | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 888 W BONNEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891060100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024836000 | ||||||||
| FaxNumber: | 7024836028 | ||||||||
| Practice Location | |||||||||
| Address1: | 888 W BONNEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891060100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024836000 | ||||||||
| FaxNumber: | 7024836028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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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 | 103T00000X | PY275 | NV | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | PY275 | 01 | NV | STATE LICENSE | OTHER | 1538147855 | 05 | NV | MEDICAID |