Healthcare Provider Details

I. General information

NPI: 1164108486
Provider Name (Legal Business Name): LAURA MILLER PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S SAINT FRANCIS DR
SANTA FE NM
87505-4036
US

IV. Provider business mailing address

29C JACONA RD
SANTA FE NM
87506-1394
US

V. Phone/Fax

Practice location:
  • Phone: 720-308-7986
  • Fax:
Mailing address:
  • Phone: 206-409-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA D MILLER
Title or Position: OWNER
Credential: LPCC
Phone: 206-409-7451