Provider Demographics
NPI:1104048891
Name:MILLER, JONATHAN (LPC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 MEADOWCREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4663
Mailing Address - Country:US
Mailing Address - Phone:972-509-7881
Mailing Address - Fax:314-292-1198
Practice Address - Street 1:2013 MEADOWCREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4663
Practice Address - Country:US
Practice Address - Phone:972-509-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional