Healthcare Provider Details

I. General information

NPI: 1740122068
Provider Name (Legal Business Name): CHELSEY-LEE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4296
US

IV. Provider business mailing address

650 TAMARACK AVE APT 2714
BREA CA
92821-3241
US

V. Phone/Fax

Practice location:
  • Phone: 949-467-4803
  • Fax:
Mailing address:
  • Phone: 307-761-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: