| Doctor Name: | RUSSELL W MILLER |
| NPI Number: | 1730167537 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS |
| License Number: | 2001018057 |
| Business Practice Address: | 2755 State Road Tt New Bloomfield, MO - 650631642 |
| Business Phone Number: | 5736904614 |
| Business Fax Number: | 5738968956 |
| Mailing Address: | 2755 State Road Tt, NEW BLOOMFIELD |
| State: | MO |
| Postal Code: | 650631642 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2006 |
| NPI Last Update Date: | 12/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2001018057 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |