Provider Demographics
NPI:1336675172
Name:MINER, KIM (LMHC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 US HIGHWAY 98 W STE 108
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3245
Mailing Address - Country:US
Mailing Address - Phone:850-389-8489
Mailing Address - Fax:844-377-9201
Practice Address - Street 1:12815 US HIGHWAY 98 W STE 108
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3245
Practice Address - Country:US
Practice Address - Phone:850-389-8489
Practice Address - Fax:844-377-9201
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health