Provider Demographics
NPI:1780701771
Name:MILLER, DAVID A (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2620
Mailing Address - Country:US
Mailing Address - Phone:913-345-0033
Mailing Address - Fax:913-345-0177
Practice Address - Street 1:8575 W 110TH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2620
Practice Address - Country:US
Practice Address - Phone:913-345-0033
Practice Address - Fax:913-345-0177
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS671103T00000X
MO01279103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493440705Medicaid
KS4957144501Medicaid
KS4957144501Medicaid