Provider Demographics
NPI:1164055786
Name:MILLER, LEAH (MC, LPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 5TH ST STE 1-474
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1400
Mailing Address - Country:US
Mailing Address - Phone:602-885-1842
Mailing Address - Fax:
Practice Address - Street 1:1212 5TH ST STE 1-474
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1400
Practice Address - Country:US
Practice Address - Phone:480-702-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21562101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty