Provider Demographics
NPI:1558506626
Name:MILLER, KIMBERLY JEAN (MS,NCC,LCPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS,NCC,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEADOW HEIGHTS PROFESSIONAL PARK
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:COLLINSVILE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-344-7105
Mailing Address - Fax:618-344-2506
Practice Address - Street 1:MEADOW HEIGHTS PROFESSIONAL PARK
Practice Address - Street 2:SUITE 2B
Practice Address - City:COLLINSVILE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:618-344-7105
Practice Address - Fax:618-344-2506
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health