Provider Demographics
NPI:1891207817
Name:MILLER, KARIN (ICSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ICSW
Other - Prefix:MRS
Other - First Name:KARIN
Other - Middle Name:LEE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ICSW
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-0595
Mailing Address - Country:US
Mailing Address - Phone:435-283-4690
Mailing Address - Fax:435-283-4689
Practice Address - Street 1:45 WEST 700 SOUTH
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627
Practice Address - Country:US
Practice Address - Phone:435-283-4690
Practice Address - Fax:435-283-4689
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health