Provider Demographics
NPI:1093932303
Name:MILLER, ELIZABETH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:STUITE 201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7360
Mailing Address - Country:US
Mailing Address - Phone:208-850-4502
Mailing Address - Fax:208-474-5237
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:STUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7360
Practice Address - Country:US
Practice Address - Phone:208-850-4502
Practice Address - Fax:208-474-5237
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN5756Medicare UPIN
ID000010146157Medicare UPIN