Individual
KATHRYN MILLER REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
19855 OUTER DR, 103B-W, DEARBORN, MI 48124-2022
(313) 359-1977
Mailing address
44242 ARLINGTON RD, CANTON, MI 48187-2144
(734) 516-7424
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301008955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11283769
CAQH ID
MI
01
—
38-3304817
TAX ID
MI
01
—
680H247650
BCBS PIN
MI
Enumeration date
03/16/2007
Last updated
07/08/2007
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