Healthcare Provider Details

I. General information

NPI: 1619716842
Provider Name (Legal Business Name): MICHAEL MILLER LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHA'EL MILLER LSW

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

IV. Provider business mailing address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

V. Phone/Fax

Practice location:
  • Phone: 720-473-4180
  • Fax:
Mailing address:
  • Phone: 720-473-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW.0009927134
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: