Provider Demographics
NPI:1194278465
Name:MILLER, MARY KATLYN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATLYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 THORN RUN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3102
Mailing Address - Country:US
Mailing Address - Phone:412-329-7778
Mailing Address - Fax:
Practice Address - Street 1:1150 THORN RUN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-3102
Practice Address - Country:US
Practice Address - Phone:412-329-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty