Provider Demographics
NPI:1144879412
Name:MILLER, JOHN FRANKLIN IV (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:MILLER
Suffix:IV
Gender:M
Credentials:LPC, LCDC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:FRANKLIN
Other - Last Name:MILLER
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:2010 AL LIPSCOMB WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-2773
Mailing Address - Country:US
Mailing Address - Phone:214-876-8687
Mailing Address - Fax:
Practice Address - Street 1:2010 AL LIPSCOMB WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2773
Practice Address - Country:US
Practice Address - Phone:214-876-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15371101YA0400X
TX84710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399885801Medicaid