Healthcare Provider Details

I. General information

NPI: 1699536623
Provider Name (Legal Business Name): DAVID MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MAGRILL ST
LONGVIEW TX
75601-6445
US

IV. Provider business mailing address

2960 LONG PRAIRIE RD
FLOWER MOUND TX
75022-4845
US

V. Phone/Fax

Practice location:
  • Phone: 903-502-0490
  • Fax:
Mailing address:
  • Phone: 903-402-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number89216
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: