Provider Demographics
NPI:1851070676
Name:MILLER, CHRISTY MICHELLE (LAC, NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DILLOW LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-4010
Mailing Address - Country:US
Mailing Address - Phone:479-321-6344
Mailing Address - Fax:
Practice Address - Street 1:805 N 20TH PL STE 1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3571
Practice Address - Country:US
Practice Address - Phone:479-345-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2301011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor