Active NPI
Derrius Terel Miller, DSW, LCSW
- Clinical Social Worker
- Brandon, MS
National Provider Identifier
1629564448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C7908
- Practice address
- 125 Bent Creek Dr
Brandon, MS 39047-6634 - Phone
- (601) 668-2162
- NPI assigned
- Jul 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C7908 | MS | Primary |
Addresses
Primary practice location
125 Bent Creek Dr
Brandon, MS 39047-6634
Mailing address
125 Bent Creek Dr
Brandon, MS 39047-6634
Phone (601) 668-2162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7908 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530662400000",
"number": "1629564448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 BENT CREEK DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390476634",
"telephone_number": "601-668-2162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 BENT CREEK DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390476634",
"telephone_number": "601-668-2162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "DERRIUS",
"middle_name": "TEREL",
"name_prefix": "Dr.",
"credential": "DSW, LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-07-04",
"last_updated": "2018-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C7908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.