Provider Demographics
NPI:1679846208
Name:MILLER, JUDY LEE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 N BIG SPRING ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2001
Mailing Address - Country:US
Mailing Address - Phone:432-528-1140
Mailing Address - Fax:432-684-3943
Practice Address - Street 1:5400 N BIG SPRING ST
Practice Address - Street 2:SUITE K
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2001
Practice Address - Country:US
Practice Address - Phone:432-528-1140
Practice Address - Fax:432-684-3943
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional