Provider Demographics
NPI:1225473259
Name:MILLER, CHANDRA L
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5308
Mailing Address - Country:US
Mailing Address - Phone:918-519-3786
Mailing Address - Fax:
Practice Address - Street 1:1514 E 10TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5308
Practice Address - Country:US
Practice Address - Phone:918-519-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor