MEDICARE: ANTONIO PRENTISS 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	101YM0800X	Mental Health Counselor	100447	TX

General Provider Information

NPI Number	:	1154298859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO PRENTISS MILLER

Provider Business Mailing Address
First Line	:	10628 SYLVIA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-2816
Country	:	US
Telephone Number	:	972-768-1807
Fax Number	:

Provider Business Practice Location Address
First Line	:	10628 SYLVIA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-2816
Country	:	US
Telephone Number	:	972-768-1807
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “ ANTONIO PRENTISS MILLER ” Practice Location

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