Healthcare Provider Details

I. General information

NPI: 1932131836
Provider Name (Legal Business Name): KIM M MILLER LPCC, LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S WASHINGTON ST STE G
GRAND FORKS ND
58201-8155
US

IV. Provider business mailing address

4700 S WASHINGTON ST STE G
GRAND FORKS ND
58201-8155
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-6336
  • Fax: 701-772-1030
Mailing address:
  • Phone: 701-746-6336
  • Fax: 701-772-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1271
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number962-7-15-18-342
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: