MEDICARE: CHRISTINE MILLER THERAPY LLC

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1669224028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE MILLER THERAPY LLC

Provider Business Mailing Address
First Line	:	6982 GOLDEN MESA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6982 GOLDEN MESA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3457
Country	:	US
Telephone Number	:	614-560-4347
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINE MILLER
Credential	:
Telephone Number	:	614-560-4347

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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