Provider Demographics
NPI:1154531077
Name:MILLER, KRISTA JUDITH (MS, LMFT, LCDC)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:JUDITH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LMFT, LCDC
Other - Prefix:MS
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT, LCDC
Mailing Address - Street 1:18827 SALADO CYN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-1633
Mailing Address - Country:US
Mailing Address - Phone:702-375-6590
Mailing Address - Fax:210-547-2828
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:SUITE #701
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:702-375-6590
Practice Address - Fax:210-547-2828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202114106H00000X
TX12570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)