Provider Demographics
NPI:1619321890
Name:MILLER, KEARIN ALISE
Entity Type:Individual
Prefix:
First Name:KEARIN
Middle Name:ALISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W WALKER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-2633
Mailing Address - Country:US
Mailing Address - Phone:832-671-9983
Mailing Address - Fax:
Practice Address - Street 1:1302 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3752
Practice Address - Country:US
Practice Address - Phone:713-542-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist