Basic Information
| Provider Information | |||||||||
| NPI: | 1790065357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 CONNER CAMPUS BLDG. A | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48215 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 CONNER | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132457000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2011 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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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 | 101Y00000X | 6802066094 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 6802066094 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.