Healthcare Provider Details

I. General information

NPI: 1649630344
Provider Name (Legal Business Name): MS. MIELLE BOTTOMLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MIAMI RD
MONTROSE CO
81401-4108
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-3200
  • Fax:
Mailing address:
  • Phone: 970-335-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002098
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9884949-6009
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0016136
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: