Individual
TINA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31700 W 12 MILE RD STE 100&250, FARMINGTON HILLS, MI 48334-4424
(586) 321-6179
Mailing address
172 COTTAGE DR, HORTON, MI 49246-9727
(586) 321-6179
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009261
MI
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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