Provider Demographics
NPI:1760630552
Name:MILLER, CATHERINE LISE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LAKE PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3422
Mailing Address - Country:US
Mailing Address - Phone:415-519-1627
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:714-841-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist