Provider Demographics
NPI:1396458717
Name:THOMAS-MILLER, PATRICIA FAYE (LCDC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FAYE
Last Name:THOMAS-MILLER
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 CAMP BOWIE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5543
Mailing Address - Country:US
Mailing Address - Phone:469-659-6192
Mailing Address - Fax:
Practice Address - Street 1:6115 CAMP BOWIE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5543
Practice Address - Country:US
Practice Address - Phone:469-659-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)