Provider Demographics
NPI:1689332413
Name:MILLER, LISA GARRETT (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GARRETT
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW
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 219
Mailing Address - Street 2:
Mailing Address - City:SKULL VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86338-0219
Mailing Address - Country:US
Mailing Address - Phone:727-780-4311
Mailing Address - Fax:
Practice Address - Street 1:500 AZ-89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-194641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical