Provider Demographics
NPI:1407870405
Name:MILLER, MARILYN (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 BROADWAY ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5746
Mailing Address - Country:US
Mailing Address - Phone:210-822-1708
Mailing Address - Fax:210-822-1708
Practice Address - Street 1:5108 BROADWAY ST
Practice Address - Street 2:SUITE 221
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5746
Practice Address - Country:US
Practice Address - Phone:210-822-1708
Practice Address - Fax:210-822-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional