Provider Demographics
NPI:1992897029
Name:MILLER, MELANIE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 LITTLE RD. STE 550, PMB 311
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3716
Mailing Address - Country:US
Mailing Address - Phone:972-333-9705
Mailing Address - Fax:
Practice Address - Street 1:2201 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5863
Practice Address - Country:US
Practice Address - Phone:972-333-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical