Healthcare Provider Details

I. General information

NPI: 1518526847
Provider Name (Legal Business Name): LISA MILLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE WEST PLZ STE 508
ALBANY NY
12205-5587
US

IV. Provider business mailing address

359 BALLSTON AVE
SARATOGA SPGS NY
12866-4723
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-4232
  • Fax:
Mailing address:
  • Phone: 518-587-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009402-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: