Provider Demographics
NPI:1205666799
Name:MILLER, KERRI
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 E COALTON RD APT 84-201
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4552
Mailing Address - Country:US
Mailing Address - Phone:720-534-1071
Mailing Address - Fax:
Practice Address - Street 1:1995 E COALTON RD APT 84-201
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-4552
Practice Address - Country:US
Practice Address - Phone:720-534-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO385HR2060X, 385HR2065X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO101YP2500XOtherOUT OF POCKET
CO101YS0200XOtherOUT OF POCKET
CO101YP2500XMedicaid
CO101YS0200XMedicaid