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General NPI Number Information
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NPI Number | 1639567217
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Entity Type | Individual
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Provider Name | SAMANTHA MILLER
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Gender | Female
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 350 INTERLOCKEN BLVD
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City | BROOMFIELD
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State | CO
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Zip | 80021-3477
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Country | US
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Telephone | 720-523-1116
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Fax | 720-523-1116
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Provider Business Mailing Address
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Address Line | 350 INTERLOCKEN BLVD STE 100
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City | BROOMFIELD
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State | CO
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Zip | 80021-3478
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Country | US
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Telephone | 720-523-1116
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Fax | 720-523-1116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC.0015805
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License Number State | CO
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