Provider Demographics
NPI:1679604912
Name:MILLER, KATHRYN SHAKTI (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SHAKTI
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MO PAC CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6807
Mailing Address - Country:US
Mailing Address - Phone:512-328-0814
Mailing Address - Fax:512-344-9366
Practice Address - Street 1:1007 MO PAC CIR STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6807
Practice Address - Country:US
Practice Address - Phone:512-328-0814
Practice Address - Fax:512-344-9366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612343Medicare ID - Type Unspecified