Provider Demographics
NPI:1467664813
Name:KATHRYN MILLER PHD PC
Entity Type:Organization
Organization Name:KATHRYN MILLER PHD PC
Other - Org Name:DEARBORN COUNSELING AND RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-359-1977
Mailing Address - Street 1:2881 MONROE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3475
Mailing Address - Country:US
Mailing Address - Phone:313-359-1977
Mailing Address - Fax:
Practice Address - Street 1:2881 MONROE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3475
Practice Address - Country:US
Practice Address - Phone:313-359-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008955103TC0700X
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881718864OtherINDIVIDUAL NPI
MI1881718864OtherINDIVIDUAL NPI