MEDICARE: DR. MELANIE A MILLER PSY.D.

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	103TC0700X	Clinical Psychologist	34921	TX

General Provider Information

NPI Number	:	1992897029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE A MILLER PSY.D.

Provider Business Mailing Address
First Line	:	4401 LITTLE RD. STE 550, PMB 311
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-3716
Country	:	US
Telephone Number	:	972-333-9705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 SE LOOP 820
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76119-5863
Country	:	US
Telephone Number	:	972-333-9705
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	01/13/2015

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