Provider Demographics
NPI:1659777464
Name:MILLER, LISA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12286 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5640
Mailing Address - Country:US
Mailing Address - Phone:720-352-7458
Mailing Address - Fax:720-729-8333
Practice Address - Street 1:12286 UTICA ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5640
Practice Address - Country:US
Practice Address - Phone:720-352-7458
Practice Address - Fax:720-729-8333
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CO103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst