Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 25472 | TX |
Y | 103G00000X | Clinical Psychologist | 25472 | TX |
Y | 103TC0700X | Clinical Psychologist | 25472 | TX |
NPI | 1467443432 |
---|---|
Provider Name | Monte C Miller |
First Address | San Antonio, TX 78257-1159 |
Second Address | San Antonio, TX 78257-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0795627-01 | (05) | TX |