Provider Demographics
NPI:1205266590
Name:MILLER, GREGORY T (MA, LPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NEW ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1117
Mailing Address - Country:US
Mailing Address - Phone:856-803-8479
Mailing Address - Fax:
Practice Address - Street 1:351 NEW ALBANY RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1117
Practice Address - Country:US
Practice Address - Phone:856-803-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health