Healthcare Provider Details

I. General information

NPI: 1922776343
Provider Name (Legal Business Name): ERIN MARIE MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 BALDY AVE STE A
POCATELLO ID
83201-7104
US

IV. Provider business mailing address

1494 COTTAGE AVE
POCATELLO ID
83201-6004
US

V. Phone/Fax

Practice location:
  • Phone: 208-346-7500
  • Fax:
Mailing address:
  • Phone: 281-414-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-8204
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-8204
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: