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General NPI Number Information
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NPI Number | 1558909929
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Entity Type | Individual
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Provider Name | KIM MILLER
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 59 THROCKMORTON ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-1946
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Country | US
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Telephone | 732-431-0647
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CAROUSEL CT
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City | MILLSTONE TWP
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State | NJ
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Zip | 08510-8761
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Country | US
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Telephone | 848-863-9097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37C00703500
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License Number State | NJ
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