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Individual

ANTOINETTE MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
15820 W JEFFERSON ST, GOODYEAR, AZ 85338-6893
(602) 708-0240
Mailing address
6141 E GRANT RD BLDG A, TUCSON, AZ 85712-5829
(602) 708-0240

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
320800000X
Mental Illness Community Based Residential Treatment Facility
13650767
AZ
385H00000X
Respite Care
Primary
13650767
AZ

Other

Enumeration date
11/18/2019
Last updated
08/12/2026
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