Provider Demographics
NPI:1790661288
Name:MILLER, MELEANA NAOMIROSE
Entity type:Individual
Prefix:
First Name:MELEANA
Middle Name:NAOMIROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 E FORGE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2915
Mailing Address - Country:US
Mailing Address - Phone:480-980-2351
Mailing Address - Fax:
Practice Address - Street 1:1303 S LONGMORE STE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9607
Practice Address - Country:US
Practice Address - Phone:480-712-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBACB1278563106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician