Provider Demographics
NPI:1669774170
Name:MILLER, KRISTINE KATHERINE (MA, LLPC, TLLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KATHERINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, LLPC, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 AMBERLY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1642
Mailing Address - Country:US
Mailing Address - Phone:754-200-1224
Mailing Address - Fax:
Practice Address - Street 1:15310 AMBERLY DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1642
Practice Address - Country:US
Practice Address - Phone:754-200-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012266101YM0800X
MI6301014682103TC1900X
FLMH16965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling