Provider Demographics
NPI:1215741012
Name:MILLER, SHADIE BETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHADIE
Middle Name:BETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 JOLIET AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1124
Mailing Address - Country:US
Mailing Address - Phone:806-206-3027
Mailing Address - Fax:
Practice Address - Street 1:7204 JOLIET AVE STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1124
Practice Address - Country:US
Practice Address - Phone:806-206-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional