Provider Demographics
NPI:1902202849
Name:MILLER, TASSY (MS)
Entity Type:Individual
Prefix:MS
First Name:TASSY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ROBERTS CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2825
Mailing Address - Country:US
Mailing Address - Phone:817-731-2293
Mailing Address - Fax:817-886-0841
Practice Address - Street 1:905 ROBERTS CUT OFF RD # RC
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2825
Practice Address - Country:US
Practice Address - Phone:817-731-2293
Practice Address - Fax:817-886-0841
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst