Provider Demographics
NPI:1679924609
Name:MILLER, TERESA IRISTINE (MS, MCAP, RMHCI)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:IRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, MCAP, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW 17TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2503
Mailing Address - Country:US
Mailing Address - Phone:561-265-5453
Mailing Address - Fax:561-265-5463
Practice Address - Street 1:1200 NW 17TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2503
Practice Address - Country:US
Practice Address - Phone:561-265-5453
Practice Address - Fax:561-265-5463
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-011530-2015101YA0400X
FLIMH 6973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health