Provider Demographics
NPI:1912461419
Name:MILLER, ANTONIO (CIT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 MAIN ST # A183
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4083
Mailing Address - Country:US
Mailing Address - Phone:225-335-5329
Mailing Address - Fax:
Practice Address - Street 1:11408 LAKE SHERWOOD AVE N
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0420
Practice Address - Country:US
Practice Address - Phone:225-261-7143
Practice Address - Fax:225-250-1026
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YA0400X, 101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health