Provider Demographics
NPI:1407108327
Name:MILLER, BARTON DAVID (LCSW, LCDC)
Entity Type:Individual
Prefix:MR
First Name:BARTON
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3007
Mailing Address - Country:US
Mailing Address - Phone:817-927-3039
Mailing Address - Fax:
Practice Address - Street 1:2608 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3007
Practice Address - Country:US
Practice Address - Phone:817-927-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical