Individual
JACOB MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
(360) 423-5086
Mailing address
PO BOX 1847, LONGVIEW, WA 98632
(360) 423-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
60890150
WA
Other
Enumeration date
09/13/2018
Last updated
08/14/2019
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