Individual
CHARISSE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11715 S STATE ST APT J103, DRAPER, UT 84020-6935
(801) 889-0265
Mailing address
11715 S STATE ST APT J103, DRAPER, UT 84020-6935
(801) 889-0265
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
801998991
SELECT HEALTH
UT
Enumeration date
08/15/2019
Last updated
08/15/2019
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