Healthcare Provider Details

I. General information

NPI: 1609693621
Provider Name (Legal Business Name): CATHERINE CELESTE MILLER LCPC, BC-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 09/21/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W TOUHY AVE
CHICAGO IL
60626-2609
US

IV. Provider business mailing address

1751 W HOWARD ST STE D 214
CHICAGO IL
60626
US

V. Phone/Fax

Practice location:
  • Phone: 312-890-2676
  • Fax:
Mailing address:
  • Phone: 510-368-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014736
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberBC-DMT-1367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: