Healthcare Provider Details

I. General information

NPI: 1043829310
Provider Name (Legal Business Name): CAITLIN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LINE AVENUE SUITE 225
SHREVEPORT LA
71101
US

IV. Provider business mailing address

185 BURT BLVD STE B
BENTON LA
71006-4904
US

V. Phone/Fax

Practice location:
  • Phone: 318-754-3890
  • Fax: 318-658-9012
Mailing address:
  • Phone: 318-935-5007
  • Fax: 318-716-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8312
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: