Individual
MARCUS MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
500 MEDICAL DR, WENTZVILLE, MO 63385-3421
(314) 344-6700
(314) 344-6194
Mailing address
500 MEDICAL DR, WENTZVILLE, MO 63385-3421
(636) 466-4210
(314) 344-6194
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033541347
—
MO
05
—
431343281
—
MO
Enumeration date
01/30/2019
Last updated
01/30/2019
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