Basic Information
| Provider Information | |||||||||
| NPI: | 1295959740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 E DANIEL ST | ||||||||
| Address2: | DEPT. OF PSYCHOLOGY, U. ILLINOIS | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618206232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330631 | ||||||||
| FaxNumber: | 2172445876 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 E DANIEL ST | ||||||||
| Address2: | DEPT. OF PSYCHOLOGY, U. ILLINOIS | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618206232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330631 | ||||||||
| FaxNumber: | 2172445876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.