Provider Demographics
NPI:1083229264
Name:MILLER, ALEXA RAE (MSW)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 TELEGRAPH RD APT 1408
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2202 S CEDAR ST STE 175
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2310
Practice Address - Country:US
Practice Address - Phone:317-937-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2025-01-14
Deactivation Date:2023-01-27
Deactivation Code:
Reactivation Date:2023-03-07
Provider Licenses
StateLicense IDTaxonomies
WA616193691041C0700X
106S00000X, 171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker