Provider Demographics
NPI:1255067815
Name:MILLER, MARGAUX ELENA
Entity type:Individual
Prefix:
First Name:MARGAUX
Middle Name:ELENA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
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 334
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-0251
Mailing Address - Country:US
Mailing Address - Phone:203-595-1498
Mailing Address - Fax:
Practice Address - Street 1:524 CLEVELAND BLVD STE 205
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4080
Practice Address - Country:US
Practice Address - Phone:208-465-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor