Provider Demographics
NPI:1003661299
Name:DR. KATY KOPP MILLER, LLC
Entity type:Organization
Organization Name:DR. KATY KOPP MILLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERYNE
Authorized Official - Middle Name:KOPP
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:765-425-3412
Mailing Address - Street 1:120 W 7TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3835
Mailing Address - Country:US
Mailing Address - Phone:765-425-3412
Mailing Address - Fax:
Practice Address - Street 1:120 W 7TH ST STE 108
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3835
Practice Address - Country:US
Practice Address - Phone:765-425-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health