MEDICARE: MS. KARI MILLER ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	23211	CA
2	101YM0800X	Mental Health Counselor	23211	CA
3	101YP2500X	Professional Counselor	23211	CA
4	104100000X	Social Worker	23211	CA
5	1041C0700X	Clinical Social Worker	23211	CA
6	171M00000X	Case Manager/Care Coordinator	23211	CA

General Provider Information

NPI Number	:	1154698959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARI MILLER ASW

Provider Business Mailing Address
First Line	:	PO BOX 4181
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94531-4181
Country	:	US
Telephone Number	:	707-971-9120
Fax Number	:	925-206-4961

Provider Business Practice Location Address
First Line	:	1652 W TEXAS ST
Second Line	:	135
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6066
Country	:	US
Telephone Number	:	707-971-9120
Fax Number	:	925-206-4961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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