Provider Demographics
NPI:1164011847
Name:MILLER, KYLE (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:PA
Mailing Address - Zip Code:17501-1222
Mailing Address - Country:US
Mailing Address - Phone:717-440-0246
Mailing Address - Fax:
Practice Address - Street 1:263 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1222
Practice Address - Country:US
Practice Address - Phone:717-440-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional