NPIMap

Organization Active NPI

Kathryn Miller PHD PC

Doing business as Dearborn Counseling and Resource Center

  • Clinical Psychologist
  • Dearborn, MI
National Provider Identifier
1467664813
Registry record updated Apr 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301008955 Issued in MI
Legal business name
KATHRYN MILLER PHD PC
Doing business as
Dearborn Counseling and Resource Center
Practice address
2881 Monroe St
Suite 201
Dearborn, MI 48124-3475
Phone
(313) 359-1977
NPI assigned
May 5, 2007
Last updated
Apr 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathryn M Reilly, PH.D.NPI 1881718864
Title
President
Phone
(313) 359-1977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301008955 MI Primary
Clinical Social Worker 1041C0700X MI

Addresses

Primary practice location

2881 Monroe St
Suite 201
Dearborn, MI 48124-3475

Mailing address

2881 Monroe St
Suite 201
Dearborn, MI 48124-3475
Phone (313) 359-1977

Other identifiers 1

IdentifierTypeStateIssuer
1881718864OtherMIINDIVIDUAL NPI

Other names 1

  • DEARBORN COUNSELING AND RESOURCE CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040924001038 MI Part B Supplier - Clinic/Group Practice 0042289274 Receives reassigned benefits from 16 practitioners
Practice locations: Dearborn, MI

National Provider Directory

National Provider Directory

Locations

19855 Outer Dr
Ste 103B
Dearborn, MI 48124
Phone (313) 359-1977

19855 Outer Dr
Ste 300W
Dearborn, MI 48124
Phone (313) 359-1977

2881 Monroe St
Ste 201
Dearborn, MI 48124
Phone (313) 359-1977

2881 Monroe St
Ste 201A
Dearborn, MI 48124
Phone (313) 359-1977

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1467664813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2881 MONROE ST",
            "address_2": "SUITE 201",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243475",
            "telephone_number": "313-359-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2881 MONROE ST",
            "address_2": "SUITE 201",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243475",
            "telephone_number": "313-359-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHRYN MILLER PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-05",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-359-1977",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008955",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1881718864",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEARBORN COUNSELING AND RESOURCE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.