Provider Demographics
NPI:1275040156
Name:MILLER, ALEXANDRIA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2904
Mailing Address - Country:US
Mailing Address - Phone:419-604-9134
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE E104
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2568
Practice Address - Country:US
Practice Address - Phone:866-300-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-16-27264106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician