Provider Demographics
NPI:1144495714
Name:MILLER, MARK ALLAN (LMFT, LADC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ROBERTA LN # 103-4
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6803
Mailing Address - Country:US
Mailing Address - Phone:775-359-4044
Mailing Address - Fax:775-359-4044
Practice Address - Street 1:875 ROBERTA LN # 103-4
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6803
Practice Address - Country:US
Practice Address - Phone:775-359-4044
Practice Address - Fax:775-359-4044
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV187-L101YA0400X
NV376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)