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NPI Code Detail

MEDICARE: STACEY ALAN MILLER MSW

MEDICARE: STACEY ALAN MILLER MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1568198810
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY ALAN MILLER MSW
Provider Business Mailing Address
First Line : 370 SEDONA DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-2834
Country : US
Telephone Number : 719-367-9301
Fax Number :
Provider Business Practice Location Address
First Line : 4360 MONTEBELLO DR STE 400
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-7224
Country : US
Telephone Number : 719-367-9301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2022
Last Update Date : 07/28/2022

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