Provider Demographics
NPI:1992008601
Name:MILLER, KYLE RAYMOND (MA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:RAYMOND
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 175TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2077
Mailing Address - Country:US
Mailing Address - Phone:773-357-6361
Mailing Address - Fax:773-360-8367
Practice Address - Street 1:920 175TH ST STE 6
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2077
Practice Address - Country:US
Practice Address - Phone:773-357-6361
Practice Address - Fax:708-360-8367
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional