Fawn Gabrielle Miller, LMFT, APCC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

116646 Issued in CA

Practice address

150 S 5TH St Ste 825
Minneapolis, MN 55402-4200

Phone

(877) 441-0121

NPI assigned

Oct 20, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Fawn Dahler Former name

Medicare fee-for-service enrollment

Enrolled in CA, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Marriage and Family Therapist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fusion Care Group a Psychological Professional CorporationGroup PAC ID 8921433590, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Fusion Care Group, a Psychological Professional Corporation

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1275177982

  CO

  Medicare reassignment Care Compare group NPD
• Optum Behavioral Care of California, P.C.

  • Clinical Social Worker
  • Costa Mesa, CA
  • NPI 1447137740
  NPD (past)

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1780135251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1910",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "925491910",
            "telephone_number": "915-259-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S 5TH ST STE 825",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554024200",
            "telephone_number": "877-441-0121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 S Beacon St",
            "address_purpose": "LOCATION",
            "city": "San Pedro",
            "state": "CA",
            "postal_code": "907313740",
            "country_code": "US",
            "telephone_number": "310-547-3341 x342",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4281 Katella Ave",
            "address_purpose": "LOCATION",
            "city": "Los Alamitos",
            "state": "CA",
            "postal_code": "907203500",
            "country_code": "US",
            "telephone_number": "330-354-3505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "FAWN",
        "middle_name": "GABRIELLE",
        "credential": "LMFT, APCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-20",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "4537",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "9391",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "1846",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "116646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FAWN",
            "last_name": "DAHLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Miller
• Deanna Miller, DDS
• Derek Miller, DDS
• Erin Michelle Miller
• Fanny D Guarnizo Miller, LICSW
• Gary Thomas Miller, D.C.
• Heather Lauren Miller, M.D.
• Ingrid E Miller
• Isaac Andrew Miller, PA-C
• Ivy Miller, PH.D., L.P.

• Marriage & Family Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.