Healthcare Provider Details

I. General information

NPI: 1932308962
Provider Name (Legal Business Name): DENNIS R MILLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 JOHN T WHITE RD
FORT WORTH TX
76120-3311
US

IV. Provider business mailing address

PO BOX 428
ARLINGTON TX
76004-0428
US

V. Phone/Fax

Practice location:
  • Phone: 817-338-9553
  • Fax:
Mailing address:
  • Phone: 817-338-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 10983
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW15499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: