Provider Demographics
NPI:1053654517
Name:MILLER, JEFFREY LYNN (EDD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1026
Mailing Address - Country:US
Mailing Address - Phone:216-644-9671
Mailing Address - Fax:
Practice Address - Street 1:2186 AMBLESIDE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4620
Practice Address - Country:US
Practice Address - Phone:216-721-1400
Practice Address - Fax:216-721-5640
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH061047101YA0400X
OH00643103K00000X
OH00121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst