Individual
MISTALA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
120 S 13TH ST, ST MARIES, ID 83861-1627
(208) 245-4363
(208) 245-4349
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299
(208) 625-2070
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW36012
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38874
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2122473
—
WA
Enumeration date
09/13/2016
Last updated
07/08/2024
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