Provider Demographics
NPI:1639690183
Name:MILLER, WADE RYAN (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:RYAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18733 MANGAN WAY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3498
Mailing Address - Country:US
Mailing Address - Phone:512-983-1200
Mailing Address - Fax:
Practice Address - Street 1:13207 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-5000
Practice Address - Country:US
Practice Address - Phone:512-983-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645571041C0700X
101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health