| Doctor Name: | DR. MICHELLE RENNE MILLER |
| NPI Number: | 1003929456 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 20042044A |
| Business Practice Address: | 4630 W Jefferson Blvd #11 Fort Wayne, IN - 468046856 |
| Business Phone Number: | 2604341606 |
| Business Fax Number: | |
| Mailing Address: | 327 W 100 S, HUNTINGTON |
| State: | IN |
| Postal Code: | 467509190 |
| Phone Number: | 2602242972 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 20042044A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |