Provider Demographics
NPI:1164745295
Name:MIKLES, HOLLY M (BA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:M
Last Name:MIKLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4240
Mailing Address - Country:US
Mailing Address - Phone:580-338-2117
Mailing Address - Fax:580-338-1262
Practice Address - Street 1:306 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4240
Practice Address - Country:US
Practice Address - Phone:580-338-2117
Practice Address - Fax:580-338-1262
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherBEHAVIOR HEALTH