Provider Demographics
NPI:1700921582
Name:MILLER, JASON BRYAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRYAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 S MILL ST UNIT 964
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93061-7042
Mailing Address - Country:US
Mailing Address - Phone:805-229-1341
Mailing Address - Fax:866-424-7388
Practice Address - Street 1:5450 RALSTON ST STE 206
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6042
Practice Address - Country:US
Practice Address - Phone:805-242-0500
Practice Address - Fax:866-424-7388
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist