Provider Demographics
NPI:1558002261
Name:MILLER, HEATHER ANGELIQUE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANGELIQUE
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 1:8031 PONY HILLS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6084
Mailing Address - Country:US
Mailing Address - Phone:970-200-0431
Mailing Address - Fax:
Practice Address - Street 1:8031 PONY HILLS PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6084
Practice Address - Country:US
Practice Address - Phone:970-200-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician