Provider Demographics
NPI:1902134067
Name:MILLER, ALI (MFT)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2050
Mailing Address - Country:US
Mailing Address - Phone:415-820-1433
Mailing Address - Fax:
Practice Address - Street 1:1600 SHATTUCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1634
Practice Address - Country:US
Practice Address - Phone:415-820-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist