Provider Demographics
NPI:1861605834
Name:MILLER, SHAWN M (PH D)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W 100 S
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3739
Mailing Address - Country:US
Mailing Address - Phone:435-654-4037
Mailing Address - Fax:435-654-4077
Practice Address - Street 1:722 W 100 S
Practice Address - Street 2:SUITE # 1
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3739
Practice Address - Country:US
Practice Address - Phone:435-654-4037
Practice Address - Fax:435-654-4077
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8070738-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical