Provider Demographics
NPI:1609693621
Name:MILLER, CATHERINE CELESTE (LCPC, BC-DMT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CELESTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 W HOWARD ST
Mailing Address - Street 2:STE D 214
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:510-368-4658
Mailing Address - Fax:
Practice Address - Street 1:1360 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2609
Practice Address - Country:US
Practice Address - Phone:312-890-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014736101YP2500X
ILBC-DMT-1367225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist