Provider Demographics
NPI:1700963923
Name:MILLER, STEPHANIE LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:PELTON-MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2003 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-2624
Mailing Address - Country:US
Mailing Address - Phone:254-200-1898
Mailing Address - Fax:254-699-3984
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:254-286-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1709891-01Medicaid