Provider Demographics
NPI:1801922141
Name:MILLER, HOMER MARTIN LUTHER (PHD)
Entity type:Individual
Prefix:
First Name:HOMER
Middle Name:MARTIN LUTHER
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:H. MARTIN
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:411 OAK ST
Mailing Address - Street 2:STERLING MEDICAL ASSOCIATES ATTN CREDENTIALS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2598
Mailing Address - Country:US
Mailing Address - Phone:513-984-1800
Mailing Address - Fax:513-984-4909
Practice Address - Street 1:411 OAK ST
Practice Address - Street 2:STERLING MEDICAL ASSOCIATES
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2598
Practice Address - Country:US
Practice Address - Phone:513-984-1800
Practice Address - Fax:513-984-4909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3677103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling