Basic Information
| Provider Information | |||||||||
| NPI: | 1649781469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JULIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17117 40TH AVE W | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980377015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104659355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2621 BICKFORD AVE STE C | ||||||||
| Address2: | |||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2017 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CB60790605 | WA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | BA60856330 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.