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NPI Code Detail

MEDICARE: AVERY MILLER LMHC

MEDICARE: AVERY MILLER LMHC
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
1106S00000XBehavior Technician
2101YM0800XMental Health CounselorCTB-2023-0774NM

General Provider Information

NPI Number : 1881209831
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY MILLER LMHC
Provider Business Mailing Address
First Line : 901 RIO GRANDE BLVD NW STE H160
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2063
Country : US
Telephone Number : 505-278-0807
Fax Number :
Provider Business Practice Location Address
First Line : 901 RIO GRANDE BLVD NW STE H160
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2063
Country : US
Telephone Number : 505-278-0807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2020
Last Update Date : 11/06/2023

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Directions to “ AVERY MILLER LMHC” Practice Location

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