Healthcare Provider Details

I. General information

NPI: 1295064822
Provider Name (Legal Business Name): MS. NATALIE M MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRL STE B
SANTA FE NM
87505-4787
US

IV. Provider business mailing address

1800 OLD PECOS TRL STE B
SANTA FE NM
87505-4787
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-2908
  • Fax:
Mailing address:
  • Phone: 505-577-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0092121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: