Healthcare Provider Details

I. General information

NPI: 1376233056
Provider Name (Legal Business Name): ELISE A MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N 17TH ST STE 230
COLORADO SPRINGS CO
80904-3577
US

IV. Provider business mailing address

617 N 17TH ST STE 230
COLORADO SPRINGS CO
80904-3577
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-5121
  • Fax:
Mailing address:
  • Phone: 719-357-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0023869
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: