1588703136 NPI number — COLLEEN PATRICIA MILLER LMFT LPC

Table of content: COLLEEN PATRICIA MILLER LMFT LPC (NPI 1588703136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588703136 NPI number — COLLEEN PATRICIA MILLER LMFT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
COLLEEN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUGAN
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588703136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 E 41ST STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-357-0100
Provider Business Mailing Address Fax Number:
605-357-0190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 E 41ST STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-357-0100
Provider Business Practice Location Address Fax Number:
605-357-0190
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC 626 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: LMFT 1120 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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