Provider Demographics
NPI:1275866246
Name:MILLER, TATUM MARIE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TATUM
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N 1ST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1451
Mailing Address - Country:US
Mailing Address - Phone:208-304-4123
Mailing Address - Fax:208-597-7077
Practice Address - Street 1:212 N 1ST AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1451
Practice Address - Country:US
Practice Address - Phone:208-304-4123
Practice Address - Fax:208-597-7077
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health