Provider Demographics
NPI:1235976390
Name:MILLER, KEYALLA CHEYENNE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KEYALLA
Middle Name:CHEYENNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 BARKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2520
Mailing Address - Country:US
Mailing Address - Phone:864-207-0033
Mailing Address - Fax:
Practice Address - Street 1:303 N CARROLL BLVD STE 114
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-9075
Practice Address - Country:US
Practice Address - Phone:940-800-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health