Provider Demographics
NPI:1073077673
Name:MILLER, HOBERT STANLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:HOBERT
Middle Name:STANLEY
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9636
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2636
Mailing Address - Country:US
Mailing Address - Phone:936-645-9939
Mailing Address - Fax:903-253-0466
Practice Address - Street 1:15360 FM 850
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-3916
Practice Address - Country:US
Practice Address - Phone:936-645-9939
Practice Address - Fax:903-253-0466
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82-5234611OtherNONE PROFIT ORGANIZATION