Healthcare Provider Details

I. General information

NPI: 1790887701
Provider Name (Legal Business Name): KAREN S MILLER LCSW,CADACII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 427 BOX 4226
APO AE
09630
IT

IV. Provider business mailing address

CMR 427 BOX 4226
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 44-471-7554
  • Fax: 44-471-8380
Mailing address:
  • Phone: 390444717554
  • Fax: 300444718380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICRC21155
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADACII#121
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSO8078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: