Provider Demographics
NPI:1407342512
Name:MILLER-ELLIS, LAURIE ANN (MS, MS, LPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:MILLER-ELLIS
Suffix:
Gender:F
Credentials:MS, MS, LPC
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MS, LPC
Mailing Address - Street 1:3428 PIEDMONT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-3569
Mailing Address - Country:US
Mailing Address - Phone:907-885-1900
Mailing Address - Fax:
Practice Address - Street 1:3428 PIEDMONT LAKE RD
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-3569
Practice Address - Country:US
Practice Address - Phone:907-885-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK118151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional