Provider Demographics
NPI:1487664785
Name:MILLS, STEVEN WAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:MILLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7315
Mailing Address - Country:US
Mailing Address - Phone:405-615-4608
Mailing Address - Fax:405-275-7105
Practice Address - Street 1:126 N BELL AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6902
Practice Address - Country:US
Practice Address - Phone:405-275-7100
Practice Address - Fax:405-275-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical