Provider Demographics
NPI:1285867614
Name:STEPHANIE A. MILLER LPC
Entity Type:Organization
Organization Name:STEPHANIE A. MILLER LPC
Other - Org Name:STEPHANIE A. MILLER LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-329-0457
Mailing Address - Street 1:301 U.S HIGHWAY 59 SOUTH LOOP
Mailing Address - Street 2:SUITE C
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351
Mailing Address - Country:US
Mailing Address - Phone:936-329-0457
Mailing Address - Fax:936-329-0472
Practice Address - Street 1:301 U.S HIGHWAY 59 SOUTH LOOP
Practice Address - Street 2:SUITE C
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-329-0457
Practice Address - Fax:936-329-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027618003Medicaid