Provider Demographics
NPI:1619075223
Name:MILLER, MICHELLE J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9334
Mailing Address - Country:US
Mailing Address - Phone:406-560-6600
Mailing Address - Fax:
Practice Address - Street 1:24 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9334
Practice Address - Country:US
Practice Address - Phone:406-560-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000071445OtherBCBS
MT0503763Medicaid
MT0503763Medicaid