Basic Information
| Provider Information | |||||||||
| NPI: | 1376811422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | MARIE CHRISTIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 THUNDERSTICK DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405059010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592541035 | ||||||||
| FaxNumber: | 8592542075 | ||||||||
| Practice Location | |||||||||
| Address1: | 21350 W 153RD ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133222400 | ||||||||
| FaxNumber: | 9136215730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3907 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7100306250 | 05 | KY | MEDICAID |