Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 78666 | TX |
NPI | 1003481789 |
---|---|
Provider Name | Stephen Dale Miller |
First Address | New Braunfels, TX 78132-2908 |
Second Address | New Braunfels, TX 78130-6895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |