Provider Demographics
NPI:1124624424
Name:MILLETT, NATALIE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MILLETT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 BOND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3501
Mailing Address - Country:US
Mailing Address - Phone:208-391-3141
Mailing Address - Fax:
Practice Address - Street 1:1152 BOND AVE STE B
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3501
Practice Address - Country:US
Practice Address - Phone:208-391-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7725251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health