Provider Demographics
NPI:1043369291
Name:MILLER, CAROLE SUSAN (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:SUSAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 ASCOT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5422
Mailing Address - Country:US
Mailing Address - Phone:409-898-3081
Mailing Address - Fax:409-833-4811
Practice Address - Street 1:85 INTERSTATE 10 NORTH
Practice Address - Street 2:SUITE 201
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-5422
Practice Address - Country:US
Practice Address - Phone:409-898-3081
Practice Address - Fax:409-833-4811
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08903101Y00000X
TX1349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist