Provider Demographics
NPI:1912155805
Name:MILLER, RAY WAYNE (LCSW)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 ROBBIE RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-6475
Mailing Address - Country:US
Mailing Address - Phone:337-322-3030
Mailing Address - Fax:
Practice Address - Street 1:319 ROBBIE RD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-6475
Practice Address - Country:US
Practice Address - Phone:337-322-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALCSW #45941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical