MEDICARE: SYREETA MILLER

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
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor		TX

General Provider Information

NPI Number	:	1134753460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYREETA MILLER

Provider Business Mailing Address
First Line	:	5419 STILL MEADOW LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4141
Country	:	US
Telephone Number	:	832-766-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 STILL MEADOW LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4141
Country	:	US
Telephone Number	:	832-766-1172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	08/08/2024

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