Provider Demographics
NPI:1932445939
Name:MILLER, COURTNEY KARONE
Entity Type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:KARONE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1513
Mailing Address - Country:US
Mailing Address - Phone:501-660-6868
Mailing Address - Fax:501-660-6838
Practice Address - Street 1:6425 WEST 12TH
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72225-1970
Practice Address - Country:US
Practice Address - Phone:501-666-8686
Practice Address - Fax:507-660-6838
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health