Individual
JORDAN R MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
3048 E BASELINE RD STE 107, MESA, AZ 85204-7287
(480) 452-2556
Mailing address
5359 E ELMWOOD ST, MESA, AZ 85205-5440
(480) 528-1784
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-6046T
AZ
Other
Enumeration date
06/07/2019
Last updated
06/11/2019
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