Provider Demographics
NPI:1770730244
Name:MILLER, STACY L (PCC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 EMERALD PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6235
Mailing Address - Country:US
Mailing Address - Phone:614-503-0664
Mailing Address - Fax:614-503-0665
Practice Address - Street 1:6500 EMERALD PKWY
Practice Address - Street 2:STE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-6235
Practice Address - Country:US
Practice Address - Phone:614-503-0664
Practice Address - Fax:614-503-0665
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0701075251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health