Basic Information
| Provider Information | |||||||||
| NPI: | 1043440332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432012460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142996600 | ||||||||
| FaxNumber: | 6142999007 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432152204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142276865 | ||||||||
| FaxNumber: | 6142276873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 07/21/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0600264 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.