Provider Demographics
NPI:1669916938
Name:MILLER, KATHERINE FAYE (BA, MS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:FAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OLD SHELL HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:FL
Mailing Address - Zip Code:32189-3307
Mailing Address - Country:US
Mailing Address - Phone:386-546-5812
Mailing Address - Fax:
Practice Address - Street 1:23 RYBAR LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6445
Practice Address - Country:US
Practice Address - Phone:386-316-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3621101YM0800X, 103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113573500Medicaid
FL102040500Medicaid