Provider Demographics
NPI:1902512585
Name:MILLER, ANGELA GUINIVERE (TEMP-LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GUINIVERE
Last Name:MILLER
Suffix:
Gender:F
Credentials:TEMP-LMHCA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:GUINIVERE
Other - Last Name:HUIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:654 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2159
Mailing Address - Country:US
Mailing Address - Phone:812-369-4344
Mailing Address - Fax:812-369-4314
Practice Address - Street 1:654 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2159
Practice Address - Country:US
Practice Address - Phone:812-369-4344
Practice Address - Fax:812-369-4314
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99115919A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health