Provider Demographics
NPI:1871001651
Name:MILLER, MELISSA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W ROSEDALE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2826
Mailing Address - Country:US
Mailing Address - Phone:817-377-4011
Mailing Address - Fax:
Practice Address - Street 1:1300 W ROSEDALE ST STE 8
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2826
Practice Address - Country:US
Practice Address - Phone:817-377-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker