1184614133 NPI number — DR. CARL SCOTT MILLER LCSW, BCD, PHD

Table of content: DR. CARL SCOTT MILLER LCSW, BCD, PHD (NPI 1184614133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184614133 NPI number — DR. CARL SCOTT MILLER LCSW, BCD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
CARL
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, BCD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184614133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1262 SUGAR LAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-627-8953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 MDOS/SGOH
Provider Second Line Business Practice Location Address:
UNIT 2060
Provider Business Practice Location Address City Name:
OSAN AB
Provider Business Practice Location Address State Name:
UNK
Provider Business Practice Location Address Postal Code:
APO AP 962782060
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
7842148
Provider Business Practice Location Address Fax Number:
7842630
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  905 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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