Provider Demographics
NPI:1174126767
Name:MILLER, PRISCILLA (BCBA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:
Practice Address - Street 1:112 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3316
Practice Address - Country:US
Practice Address - Phone:903-251-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3755103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst