Provider Demographics
NPI:1568486645
Name:MILLER, KATHARINE L (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:L
Other - Last Name:THURLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMLP
Mailing Address - Street 1:2430 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2729
Mailing Address - Country:US
Mailing Address - Phone:702-247-9994
Mailing Address - Fax:
Practice Address - Street 1:2430 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2729
Practice Address - Country:US
Practice Address - Phone:702-247-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1039101Y00000X
NVPY1023103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS839984OtherBCBS
11758846OtherCAQH
KS200437150AMedicaid