Provider Demographics
NPI:1073954624
Name:MILLER, COURTNEY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 232ND ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4637
Mailing Address - Country:US
Mailing Address - Phone:425-835-2831
Mailing Address - Fax:
Practice Address - Street 1:5803 232ND ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4637
Practice Address - Country:US
Practice Address - Phone:425-835-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC602271411041C0700X
WALW604970491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical