Healthcare Provider Details

I. General information

NPI: 1619716842
Provider Name (Legal Business Name): MICHA'EL MILLER LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 38TH ST STE 100
BOULDER CO
80301-2623
US

IV. Provider business mailing address

1650 38TH ST STE 100
BOULDER CO
80301-2623
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.000927134
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: