Rebecca Jo Miller, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-7210 Issued in ID

Practice address

1032 S Bridgeway PL
Eagle, ID 83616-6099

Phone

(208) 246-0123

Fax

(208) 246-0125

NPI assigned

Mar 5, 2019

Last updated

Mar 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bridgeway Health Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eagle, ID
  • NPI 1073811097
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1730647116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 S COLUMBUS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837054340",
            "telephone_number": "208-866-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S BRIDGEWAY PL",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166099",
            "telephone_number": "208-246-0123",
            "fax_number": "208-246-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "REBECCA",
        "middle_name": "JO",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-7210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LPC-7210",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Marie Miles, M.A., LMFT
• Iris June Miller Gallegos, LCSW
• Alan Paul Miller, M.D.
• Breanne Miller
• Jonathan D Miller, MD
• Sarah Miller, OTA
• Michael R, Minas, MD
• Jennica Mitchell, LCSW
• Jill Mitchell, PH.D.
• Kristen Mitchell, DPT

• Mental Health Counselor in Eagle, ID
• Providers in Eagle, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.