Provider Demographics
NPI:1164931366
Name:MILLER, LORI ANNETTE FOSTER (MCOUN, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANNETTE FOSTER
Last Name:MILLER
Suffix:
Gender:F
Credentials:MCOUN, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PROFESSIONAL PLZ STE 220
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 PROFESSIONAL PLZ STE 220
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2019
Practice Address - Country:US
Practice Address - Phone:208-821-3554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6522101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor