Provider Demographics
NPI:1053824201
Name:MILLER, BERNADETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CHAMA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3594
Mailing Address - Country:US
Mailing Address - Phone:505-331-0369
Mailing Address - Fax:
Practice Address - Street 1:540 CHAMA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3594
Practice Address - Country:US
Practice Address - Phone:505-331-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
T-0192761101YM0800X
NMT-0192761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health