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General NPI Number Information
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NPI Number | 1760907455
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Entity Type | Individual
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Provider Name | LACEY MILLER
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 495 GRAND BLVD SUITE 206
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-1408
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Country | US
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Telephone | 470-350-4138
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Fax | 321-250-7463
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Provider Business Mailing Address
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Address Line | 495 GRAND BLVD STE 206
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-1408
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Country | US
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Telephone | 470-350-4138
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Fax | 321-250-7463
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42649
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License Number State | FL
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