Healthcare Provider Details

I. General information

NPI: 1467664813
Provider Name (Legal Business Name): KATHRYN MILLER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 MONROE ST SUITE 201
DEARBORN MI
48124-3475
US

IV. Provider business mailing address

2881 MONROE ST SUITE 201
DEARBORN MI
48124-3475
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-1977
  • Fax:
Mailing address:
  • Phone: 313-359-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301008955
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name: KATHRYN M REILLY
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 313-359-1977