Provider Demographics
NPI:1306146410
Name:MILLER, KIMBERLY ANNE (KIMBERLY MILLER)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:KIMBERLY MILLER
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW LISAC
Mailing Address - Street 1:3323 E MERLOT ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9083
Mailing Address - Country:US
Mailing Address - Phone:480-600-0539
Mailing Address - Fax:480-921-2673
Practice Address - Street 1:3323 E MERLOT ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9083
Practice Address - Country:US
Practice Address - Phone:480-600-0539
Practice Address - Fax:480-921-2673
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11696101YA0400X
AZLCSW129501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)