Provider Demographics
NPI:1457476244
Name:MILLER, BEVERLY D (LPCC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21515
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1515
Mailing Address - Country:US
Mailing Address - Phone:505-980-5106
Mailing Address - Fax:
Practice Address - Street 1:3939 SAN PEDRO DR NE
Practice Address - Street 2:SUITE C-4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8900
Practice Address - Country:US
Practice Address - Phone:505-980-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0114441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51682745Medicaid