Provider Demographics
NPI:1538468921
Name:MCMILLAN, DIANE (MS, UNDER LMFT SUPER)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MS, UNDER LMFT SUPER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SEABROOK RD
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1006
Mailing Address - Country:US
Mailing Address - Phone:580-436-1222
Mailing Address - Fax:
Practice Address - Street 1:231 SEABROOK RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1006
Practice Address - Country:US
Practice Address - Phone:580-436-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist