Provider Demographics
NPI:1508295692
Name:MILLER, MAGGIE (LMHC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:5125 ELLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6420
Mailing Address - Country:US
Mailing Address - Phone:940-839-8404
Mailing Address - Fax:
Practice Address - Street 1:5125 ELLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-6420
Practice Address - Country:US
Practice Address - Phone:940-839-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health