Basic Information
Provider Information | |||||||||
NPI: | 1225385180 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MILLER | ||||||||
FirstName: | TOMASANN | ||||||||
MiddleName: | ALENA | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LINDSAY | ||||||||
OtherFirstName: | TOMASANN | ||||||||
OtherMiddleName: | ALENA | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 1512 | ||||||||
Address2: |   | ||||||||
City: | COARSEGOLD | ||||||||
State: | CA | ||||||||
PostalCode: | 93614 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5594998998 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 40258 HWY 41 UNIT B | ||||||||
Address2: |   | ||||||||
City: | OAKHURST | ||||||||
State: | CA | ||||||||
PostalCode: | 93644 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5594998998 | ||||||||
FaxNumber: | 2099668251 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2012 | ||||||||
LastUpdateDate: | 10/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT78797 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 171M00000X |   |   | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 106H00000X | LMFT131473 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.