Provider Demographics
NPI:1306039631
Name:MILLER, ANGELA (LCPC, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 WILDRYE ST
Mailing Address - Street 2:PO BOX 996
Mailing Address - City:COLSTRIP
Mailing Address - State:MT
Mailing Address - Zip Code:59323-9501
Mailing Address - Country:US
Mailing Address - Phone:406-748-3395
Mailing Address - Fax:406-494-1724
Practice Address - Street 1:1 CHEYENNE LANE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-748-3395
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1302OtherSTATE FO MONTANA LICENSE