Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 87001570A | IN |
NPI | 1003314808 |
---|---|
Provider Name | Kathleen Elizabeth Miller |
First Address | Indianapolis, IN 46250-1494 |
Second Address | Indianapolis, IN 46240-2379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |