Individual
KIM M MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAC
Contact information
Practice address
2424 32ND AVE S STE 202, GRAND FORKS, ND 58201-6510
(701) 746-6336
(701) 772-1030
Mailing address
2424 32ND AVE S STE 202, GRAND FORKS, ND 58201-6510
(701) 746-6336
(701) 772-1030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1271
ND
101YP2500X
Professional Counselor
Primary
962-7-15-18-342
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012461
BCBS ND PROVIDER NUMBER
ND
01
—
9G415MI
BCBS MN PROVIDER NUMBER
MN
Enumeration date
07/07/2006
Last updated
10/09/2024
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