Provider Demographics
NPI:1073902151
Name:MILLER CABALLARO, ELYSEE VIRGINIA (LPC)
Entity Type:Individual
Prefix:
First Name:ELYSEE
Middle Name:VIRGINIA
Last Name:MILLER CABALLARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 FM 1463 RD STE 160-181
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4027
Mailing Address - Country:US
Mailing Address - Phone:346-592-1093
Mailing Address - Fax:
Practice Address - Street 1:6445 FM 1463 RD STE 160-181
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4027
Practice Address - Country:US
Practice Address - Phone:346-592-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional