Provider Demographics
NPI:1922887371
Name:MILLER, MARK CRAIG II
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CRAIG
Last Name:MILLER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3215
Mailing Address - Country:US
Mailing Address - Phone:682-500-9406
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5420
Practice Address - Country:US
Practice Address - Phone:469-535-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician