Provider Demographics
NPI:1669275954
Name:MILLER, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 4TH AVE STE B101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4707
Mailing Address - Country:US
Mailing Address - Phone:907-799-9995
Mailing Address - Fax:
Practice Address - Street 1:542 4TH AVE STE B101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4707
Practice Address - Country:US
Practice Address - Phone:907-799-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)