Basic Information
| Provider Information | |||||||||
| NPI: | 1780023606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12933 SUNSET CIR NW | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446859168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309617161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 412 LINCOLN WAY E | ||||||||
| Address2: | |||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446468404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308338516 | ||||||||
| FaxNumber: | 3308303395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C1100235 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 2098331 | 05 | OH | MEDICAID |