Provider Demographics
NPI:1528219078
Name:MILLER, JERRILEA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JERRILEA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JERRILEA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13328 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6822
Mailing Address - Country:US
Mailing Address - Phone:405-503-9249
Mailing Address - Fax:
Practice Address - Street 1:13328 EASTRIDGE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6822
Practice Address - Country:US
Practice Address - Phone:405-503-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical