Provider Demographics
NPI:1871261396
Name:MILLER, TAQUAYZAE RENEE
Entity Type:Individual
Prefix:
First Name:TAQUAYZAE
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WILD WIND TRL
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-0596
Mailing Address - Country:US
Mailing Address - Phone:252-326-3945
Mailing Address - Fax:
Practice Address - Street 1:3403B GARDEN VILLA LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6915
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-21-162692106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician