Provider Demographics
NPI:1457654592
Name:MCMILLIAN, ALFONZO SR
Entity Type:Individual
Prefix:MR
First Name:ALFONZO
Middle Name:
Last Name:MCMILLIAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11737 BLUE MOON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2004
Mailing Address - Country:US
Mailing Address - Phone:405-535-4786
Mailing Address - Fax:
Practice Address - Street 1:11737 BLUE MOON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2004
Practice Address - Country:US
Practice Address - Phone:405-535-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor