Provider Demographics
NPI:1497074371
Name:BAWDEN MILLER, KELLY (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BAWDEN 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 1:545 S VALLEY VIEW DR
Mailing Address - Street 2:46
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4405
Mailing Address - Country:US
Mailing Address - Phone:702-510-7726
Mailing Address - Fax:
Practice Address - Street 1:545 S VALLEY VIEW DR
Practice Address - Street 2:46
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4405
Practice Address - Country:US
Practice Address - Phone:702-510-7726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5360626-6006101YA0400X
UT5360626 3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)