Provider Demographics
NPI:1053332445
Name:MILLER, KIMBERLY LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 S HIGUERA ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6988
Mailing Address - Country:US
Mailing Address - Phone:805-235-1585
Mailing Address - Fax:805-540-7064
Practice Address - Street 1:3220 S HIGUERA ST STE 303
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6988
Practice Address - Country:US
Practice Address - Phone:805-235-1585
Practice Address - Fax:805-540-7064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34993106H00000X
CA34993106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist