Provider Demographics
NPI:1144798547
Name:MILLER, DAN WILLIAM (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:WILLIAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 PAVILLARD DR SPC 259
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79108-3617
Mailing Address - Country:US
Mailing Address - Phone:806-681-8247
Mailing Address - Fax:
Practice Address - Street 1:504 N KANSAS AVE STE B
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-3346
Practice Address - Country:US
Practice Address - Phone:620-604-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68837101YP2500X
KS2639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty