Healthcare Provider Details

I. General information

NPI: 1104974294
Provider Name (Legal Business Name): BONNIE GAY MILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE SUITE 215
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE SUITE 215
ALBUQUERQUE NM
87109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-9458
  • Fax: 505-265-0799
Mailing address:
  • Phone: 505-270-9458
  • Fax: 505-265-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0088311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: