Provider Demographics
NPI:1043597958
Name:MILLER, ANNA (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:RANDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27810 N 175TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1159
Mailing Address - Country:US
Mailing Address - Phone:760-498-3077
Mailing Address - Fax:
Practice Address - Street 1:9139 W THUNDERBIRD RD STE 210
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4923
Practice Address - Country:US
Practice Address - Phone:760-498-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17271101YP2500X
IL180.007411101Y00000X
IL25577101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)