Individual
MRS. LIESAL MARIE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
205 S BALLARD AVE, WYLIE, TX 75098-3640
(469) 757-4525
Mailing address
205 S BALLARD AVE, WYLIE, TX 75098-3640
(469) 757-4525
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
202138
TX
106H00000X
Marriage & Family Therapist
Primary
49391
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202138
TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS
TX
01
—
49391
CALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
02/16/2007
Last updated
05/20/2020
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