Provider Demographics
NPI:1467443432
Name:MILLER, MONTE C (PSYD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24165 IH 10 W SUITE 217-475
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-219-6151
Mailing Address - Fax:888-796-3850
Practice Address - Street 1:24165 W INTERSTATE 10
Practice Address - Street 2:SUITE 217-475
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1114
Practice Address - Country:US
Practice Address - Phone:830-885-5703
Practice Address - Fax:888-796-3850
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25472103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0795627-01Medicaid
TX0795627-01Medicaid