Provider Demographics
NPI:1780135251
Name:MILLER, FAWN GABRIELLE (LMFT, APCC)
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:GABRIELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:
Other - Last Name:DAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-1910
Mailing Address - Country:US
Mailing Address - Phone:915-259-3810
Mailing Address - Fax:
Practice Address - Street 1:150 S 5TH ST STE 825
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-4200
Practice Address - Country:US
Practice Address - Phone:877-441-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4537101YM0800X
CA9391101YP2500X
CO1846106H00000X
CA116646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional