Healthcare Provider Details

I. General information

NPI: 1285120691
Provider Name (Legal Business Name): KATIE MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E WARM SPRINGS AVE
BOISE ID
83712-6420
US

IV. Provider business mailing address

740 E WARM SPRINGS AVE
BOISE ID
83712-6420
US

V. Phone/Fax

Practice location:
  • Phone: 207-343-7797
  • Fax:
Mailing address:
  • Phone: 207-343-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-6989
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: