Healthcare Provider Details

I. General information

NPI: 1932732716
Provider Name (Legal Business Name): MIKAYLA DANIELLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 S PROGRESS WAY STE 207
PARKER CO
80134-9056
US

IV. Provider business mailing address

9908 ESCALANTE CT
PARKER CO
80134-5514
US

V. Phone/Fax

Practice location:
  • Phone: 720-968-4616
  • Fax:
Mailing address:
  • Phone: 720-968-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: