Basic Information
| Provider Information | |||||||||
| NPI: | 1780035345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLES | ||||||||
| FirstName: | SELENA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | L.P.A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEARS | ||||||||
| OtherFirstName: | SELENA | ||||||||
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| OtherCredential: | L.P.A | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1380 RIVER BEND DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752474914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147431272 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1353 N WESTMORELAND RD | ||||||||
| Address2: | BLDG F | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143337063 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 36590 | TX | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.