Provider Demographics
NPI:1679709851
Name:MILLER, MICHELLE A (LCSW, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7220 W JEFFERSON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2016
Mailing Address - Country:US
Mailing Address - Phone:858-531-0804
Mailing Address - Fax:
Practice Address - Street 1:6930 S UNIVERSITY
Practice Address - Street 2:SUITE 250
Practice Address - City:LTTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-4504
Practice Address - Country:US
Practice Address - Phone:858-531-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099230861041C0700X
CA1-07-3382103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67775233OtherMEDICAID HCBS WAIVER