Healthcare Provider Details

I. General information

NPI: 1407525512
Provider Name (Legal Business Name): LINDSEY MILLER PEER SUPPORT SPECIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date: 03/31/2026
Reactivation Date: 05/28/2026

III. Provider practice location address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

IV. Provider business mailing address

6860 BROCKTON AVE STE 9
RIVERSIDE CA
92506-3816
US

V. Phone/Fax

Practice location:
  • Phone: 760-912-7314
  • Fax:
Mailing address:
  • Phone: 760-912-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1408741020
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberDUFAYHMVWRXBJTGQ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: