Provider Demographics
NPI:1326384363
Name:MILLER, REO KIM (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:REO
Middle Name:KIM
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 SW OAK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8119
Mailing Address - Country:US
Mailing Address - Phone:781-704-8563
Mailing Address - Fax:
Practice Address - Street 1:711 COMMERCE ST STE 204
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4514
Practice Address - Country:US
Practice Address - Phone:603-692-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60772446103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-09-5710OtherBCBA
BA60772446OtherWASHINGTON STATE LICENSURE