Provider Demographics
NPI:1366123499
Name:MILLER, KATHRYN M (MS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 TAMIAMI TRL S STE 402A
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5562
Mailing Address - Country:US
Mailing Address - Phone:941-275-9183
Mailing Address - Fax:
Practice Address - Street 1:1505 TAMIAMI TRL S STE 402A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5562
Practice Address - Country:US
Practice Address - Phone:941-275-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health