Provider Demographics
NPI:1245254325
Name:MILLER, KATHLEEN M (LPCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 VILLA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8206
Mailing Address - Country:US
Mailing Address - Phone:505-327-2101
Mailing Address - Fax:505-327-7451
Practice Address - Street 1:800 E 30TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9407
Practice Address - Country:US
Practice Address - Phone:505-327-2607
Practice Address - Fax:505-327-7451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health