MEDICARE: MARY KATLYN MILLER LPC, NCC

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	101YP2500X	Professional Counselor	PC008766	PA

General Provider Information

NPI Number	:	1194278465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATLYN MILLER LPC, NCC

Provider Business Mailing Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:	412-329-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:	412-329-7778
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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