Provider Demographics
NPI:1801475561
Name:MILLER, KRISTIN MICHELLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 WHITMAN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5740
Mailing Address - Country:US
Mailing Address - Phone:512-496-8638
Mailing Address - Fax:
Practice Address - Street 1:4318 WHITMAN
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5740
Practice Address - Country:US
Practice Address - Phone:512-496-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE