Healthcare Provider Details

I. General information

NPI: 1063973139
Provider Name (Legal Business Name): CARRIE LYNN MILLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17629 K16 HWY
MC LOUTH KS
66054-5134
US

IV. Provider business mailing address

17629 K16 HWY
MC LOUTH KS
66054-5134
US

V. Phone/Fax

Practice location:
  • Phone: 913-370-0300
  • Fax:
Mailing address:
  • Phone: 913-370-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: