Provider Demographics
NPI:1932308962
Name:MILLER, DENNIS R (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76004-0428
Mailing Address - Country:US
Mailing Address - Phone:817-338-9553
Mailing Address - Fax:
Practice Address - Street 1:7525 JOHN T WHITE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3311
Practice Address - Country:US
Practice Address - Phone:817-338-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 10983101YP2500X
TXLCSW154991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108155602Medicaid
TX00S20SMedicare PIN