Healthcare Provider Details

I. General information

NPI: 1902251754
Provider Name (Legal Business Name): LUCY ANNE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 E WINDING CREEK DR STE 250
EAGLE ID
83616-7246
US

IV. Provider business mailing address

1065 E WINDING CREEK DR STE 250
EAGLE ID
83616-7246
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-9588
  • Fax:
Mailing address:
  • Phone: 208-505-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7625
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: