Provider Demographics
NPI:1619583408
Name:KYLEEMILLERPHD
Entity Type:Organization
Organization Name:KYLEEMILLERPHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-428-5263
Mailing Address - Street 1:586 WELCOME WAY SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3932
Mailing Address - Country:US
Mailing Address - Phone:919-428-5263
Mailing Address - Fax:
Practice Address - Street 1:586 WELCOME WAY SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3932
Practice Address - Country:US
Practice Address - Phone:919-428-5263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty