Healthcare Provider Details

I. General information

NPI: 1053824201
Provider Name (Legal Business Name): BERNADETTE MILLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHAMA ST NE
ALBUQUERQUE NM
87108-3594
US

IV. Provider business mailing address

540 CHAMA ST NE
ALBUQUERQUE NM
87108-3594
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-0369
  • Fax:
Mailing address:
  • Phone: 505-331-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0192761
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0192761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: