Provider Demographics
NPI:1013432681
Name:MILLER, KRISTEN ANN (BSAC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44617 S AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0311
Mailing Address - Country:US
Mailing Address - Phone:985-429-7611
Mailing Address - Fax:985-429-7616
Practice Address - Street 1:44617 S AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0311
Practice Address - Country:US
Practice Address - Phone:985-429-7611
Practice Address - Fax:985-429-7616
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4036OtherLOUISIANA ADDICTIVE DISORDERS REGULATORY AUTHORITY