Provider Demographics
NPI:1124128723
Name:MILLER, RICHARD EDWIN (LPC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWIN
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 1:800 8TH AVE STE 628
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2617
Mailing Address - Country:US
Mailing Address - Phone:817-720-5600
Mailing Address - Fax:817-720-5601
Practice Address - Street 1:800 8TH AVE STE 628
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-720-5600
Practice Address - Fax:817-720-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3789LCOtherBLUE CROSS & BLUE SHEILD
TX027896201Medicaid
TX10008748OtherAMERIGROUP
TX242273000OtherMAGELLAN PROVIDER NUMBER