Provider Demographics
NPI:1679713127
Name:MILLER, CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3305 TOM GREEN ST APT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2434
Mailing Address - Country:US
Mailing Address - Phone:512-478-1000
Mailing Address - Fax:
Practice Address - Street 1:2222 WESTERN TRAILS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1647
Practice Address - Country:US
Practice Address - Phone:512-657-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62611101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679713127Medicaid