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NPI Code Detail

MEDICARE: MS. WANDA D MILLER LCDC

MEDICARE: MS. WANDA D MILLER LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor10112TX

General Provider Information

NPI Number : 1265388813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. WANDA D MILLER LCDC
Provider Business Mailing Address
First Line : 612 JONES ST
Second Line :
City : EULESS
State : TX
Zip : 76040-5127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4701 SAMUELL BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75228-6828
Country : US
Telephone Number : 972-861-5611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/10/2026

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