Individual
CRYSTAL MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, BCBA, LBS
Contact information
Practice address
2514 N BROAD ST, PHILA, PA 19132-4013
(267) 971-0590
Mailing address
5917 ELMHURST ST, PHILA, PA 19149-3603
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
05/30/2013
Last updated
06/04/2019
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