Provider Demographics
NPI:1689180176
Name:MILLER, ELVIA MARIE (CADC)
Entity Type:Individual
Prefix:
First Name:ELVIA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4472
Mailing Address - Country:US
Mailing Address - Phone:515-494-8515
Mailing Address - Fax:515-209-7081
Practice Address - Street 1:1211 VINE ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-4472
Practice Address - Country:US
Practice Address - Phone:515-494-8515
Practice Address - Fax:515-209-7081
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09024Medicaid