Basic Information
Provider Information
NPI: 1225421084
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: ELIZABETH
MiddleName: SCHAEFER
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 715 HORIZON DR STE 225
Address2:  
City: GRAND JUNCTION
State: CO
PostalCode: 815068743
CountryCode: US
TelephoneNumber: 9706837107
FaxNumber: 9706837167
Practice Location
Address1: 405 CASTLE CREEK RD STE 207
Address2:  
City: ASPEN
State: CO
PostalCode: 81611
CountryCode: US
TelephoneNumber: 9709205555
FaxNumber: 9709205557
Other Information
ProviderEnumerationDate: 03/17/2015
LastUpdateDate: 07/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLPC.0014496COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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