Provider Demographics
NPI:1720550205
Name:MILLER, DAVID LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5302
Mailing Address - Country:US
Mailing Address - Phone:719-667-6953
Mailing Address - Fax:719-577-2553
Practice Address - Street 1:2312 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5302
Practice Address - Country:US
Practice Address - Phone:719-667-6953
Practice Address - Fax:719-577-2553
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099257691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical