Provider Demographics
NPI:1003167313
Name:MILES, MELINDA L (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:L
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:515 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5249
Mailing Address - Country:US
Mailing Address - Phone:918-284-7541
Mailing Address - Fax:
Practice Address - Street 1:515 S ELM ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5249
Practice Address - Country:US
Practice Address - Phone:918-284-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health