Healthcare Provider Details

I. General information

NPI: 1679582472
Provider Name (Legal Business Name): KAREN S. MILLER PH.D.,L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRESTWOOD EXECUTIVE CTR SUITE 207
SAINT LOUIS MO
63126-1945
US

IV. Provider business mailing address

50 CRESTWOOD EXECUTIVE CTR SUITE 207
SAINT LOUIS MO
63126-1945
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-1850
  • Fax: 314-729-1807
Mailing address:
  • Phone: 314-729-1850
  • Fax: 314-729-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: