Healthcare Provider Details

I. General information

NPI: 1720550205
Provider Name (Legal Business Name): DAVID LEE MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE
COLORADO SPRINGS CO
80907-5302
US

IV. Provider business mailing address

2312 N NEVADA AVE
COLORADO SPRINGS CO
80907-5302
US

V. Phone/Fax

Practice location:
  • Phone: 719-667-6953
  • Fax: 719-577-2553
Mailing address:
  • Phone: 719-667-6953
  • Fax: 719-577-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925769
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: