Basic Information
| Provider Information | |||||||||
| NPI: | 1659557205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.S., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1726 SE 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545224749 | ||||||||
| FaxNumber: | 9545229357 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 N ANDREWS AVE | ||||||||
| Address2: | |||||||||
| City: | WILTON MANORS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333112514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545224749 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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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 | 106H00000X | MT2677 | FL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | MT2677 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.