Provider Demographics
NPI:1043531221
Name:MILLER, DENISE LEE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:LEE
Other - Last Name:MILLER-MOLITOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-9798
Mailing Address - Country:US
Mailing Address - Phone:360-214-4397
Mailing Address - Fax:
Practice Address - Street 1:117 N 1ST ST STE 55
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2858
Practice Address - Country:US
Practice Address - Phone:360-214-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60695935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health