MEDICARE: SARAH ROSE MILLER LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0015907	CO

General Provider Information

NPI Number	:	1184218190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ROSE MILLER LPCC

Provider Business Mailing Address
First Line	:	5946 BRAVE EAGLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-2061
Country	:	US
Telephone Number	:	303-619-5856
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 N WEBER ST STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1058
Country	:	US
Telephone Number	:	719-362-0558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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