Provider Demographics
NPI:1679803654
Name:MILLER, ELIZABETH K (LPC-1238)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC-1238
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:389 ADAMS ST
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110
Mailing Address - Country:US
Mailing Address - Phone:307-885-9883
Mailing Address - Fax:
Practice Address - Street 1:389 ADAMS ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-885-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1238101Y00000X
WYPPC505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional