Provider Demographics
NPI:1336791367
Name:MILLER, KRISTINA SUSAN KAY (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SUSAN KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 S BITTERROOT PL STE 115
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-1603
Mailing Address - Country:US
Mailing Address - Phone:605-880-6675
Mailing Address - Fax:
Practice Address - Street 1:7405 S BITTERROOT PL STE 115
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-1603
Practice Address - Country:US
Practice Address - Phone:605-880-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SDLPC20595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health