Provider Demographics
NPI:1538147855
Name:MUNIC-MILLER, DONNA (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MUNIC-MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W BONNEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-0100
Mailing Address - Country:US
Mailing Address - Phone:702-483-6000
Mailing Address - Fax:702-483-6028
Practice Address - Street 1:888 W BONNEVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-0100
Practice Address - Country:US
Practice Address - Phone:702-483-6000
Practice Address - Fax:702-483-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPY275OtherSTATE LICENSE
NV1538147855Medicaid
NVPY275OtherSTATE LICENSE