Provider Demographics
NPI:1497952949
Name:MONTE C MILLER PSYD
Entity Type:Organization
Organization Name:MONTE C MILLER PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:210-219-6151
Mailing Address - Street 1:24165 IH-10 W
Mailing Address - Street 2:STE 217-475
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-892-2333
Mailing Address - Fax:855-532-9272
Practice Address - Street 1:24165 IH-10 W
Practice Address - Street 2:STE 217-475
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1159
Practice Address - Country:US
Practice Address - Phone:210-892-2333
Practice Address - Fax:855-532-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25472103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079562701Medicaid
00015KMedicare PIN
TX079562701Medicaid