Individual
JOHN CLARK MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
60 LANEDA AVENUE, SUITE 202, MANZANITA, OR 97130-0000
(971) 324-0061
(971) 606-2001
Mailing address
PO BOX 146, ROCKAWAY BEACH, OR 97136-0146
(541) 377-1631
(971) 606-2001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12-03-71
OR
1041C0700X
Clinical Social Worker
Primary
L5461
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500671647
—
OR
Enumeration date
03/29/2007
Last updated
04/23/2020
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