Provider Demographics
NPI:1669988689
Name:MILLER, KACEY M (BS, BCABA, LABA)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:BS, BCABA, LABA
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:M
Other - Last Name:BLOOMFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, BCABA, LABA
Mailing Address - Street 1:228 EMMANUEL WAY LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:KY
Mailing Address - Zip Code:40176-5037
Mailing Address - Country:US
Mailing Address - Phone:270-883-5547
Mailing Address - Fax:
Practice Address - Street 1:529 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2923
Practice Address - Country:US
Practice Address - Phone:502-633-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
KY289548106E00000X
KY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst