Healthcare Provider Details

I. General information

NPI: 1356381305
Provider Name (Legal Business Name): THOMAS BRYANT MILLER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ALICIA RD
LAKELAND FL
33801-2104
US

IV. Provider business mailing address

930 ALICIA RD
LAKELAND FL
33801-2104
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax: 863-683-4654
Mailing address:
  • Phone: 863-680-1950
  • Fax: 863-683-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH5931
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: