Provider Demographics
NPI:1053526400
Name:MILLER, ANNISE BENOIT (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANNISE
Middle Name:BENOIT
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 RAINBOW DR
Mailing Address - Street 2:#8287
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399
Mailing Address - Country:US
Mailing Address - Phone:520-820-6610
Mailing Address - Fax:
Practice Address - Street 1:182 RAINBOW DR
Practice Address - Street 2:#8287
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77399
Practice Address - Country:US
Practice Address - Phone:520-820-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical