Provider Demographics
NPI:1932565512
Name:MILLER, OLIVIA SUZANNE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SUZANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SW GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-3708
Mailing Address - Country:US
Mailing Address - Phone:817-798-3671
Mailing Address - Fax:682-990-3585
Practice Address - Street 1:2350 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3708
Practice Address - Country:US
Practice Address - Phone:817-798-3671
Practice Address - Fax:682-990-3585
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-21259103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst