Healthcare Provider Details

I. General information

NPI: 1497952949
Provider Name (Legal Business Name): MONTE C MILLER PSYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24165 IH-10 W STE 217-475
SAN ANTONIO TX
78257-1159
US

IV. Provider business mailing address

24165 IH-10 W STE 217-475
SAN ANTONIO TX
78257-1159
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-2333
  • Fax: 855-532-9272
Mailing address:
  • Phone: 210-892-2333
  • Fax: 855-532-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number25472
License Number StateTX

VIII. Authorized Official

Name: DR. MONTE MILLER
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 210-219-6151