Healthcare Provider Details

I. General information

NPI: 1396250270
Provider Name (Legal Business Name): BIONCA TAYLOR-MILLER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

8300 WYOMING BLVD NE APT 1921
ALBUQUERQUE NM
87113-2170
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2800
  • Fax:
Mailing address:
  • Phone: 313-365-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018841
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0899
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401016940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: