Provider Demographics
NPI:1033949201
Name:MILLER, GERALYN DUANA
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:DUANA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DANVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4714
Mailing Address - Country:US
Mailing Address - Phone:916-913-9377
Mailing Address - Fax:
Practice Address - Street 1:116 DANVILLE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-4714
Practice Address - Country:US
Practice Address - Phone:916-913-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS6963101Y00000X, 101YA0400X
CA134677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health