Provider Demographics
NPI:1437444965
Name:DANEEN A. MILAM, PHD, PC
Entity Type:Organization
Organization Name:DANEEN A. MILAM, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANEEN
Authorized Official - Middle Name:ADDS
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-828-3624
Mailing Address - Street 1:147 W. SUNSET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2681
Mailing Address - Country:US
Mailing Address - Phone:210-828-3624
Mailing Address - Fax:210-828-2873
Practice Address - Street 1:147 W. SUNSET RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2681
Practice Address - Country:US
Practice Address - Phone:210-828-3624
Practice Address - Fax:210-828-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033612501Medicaid
TX00GK47Medicare PIN