Provider Demographics
NPI:1598188203
Name:MILLENNIUM COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:MILLENNIUM COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-627-0276
Mailing Address - Street 1:507 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4215
Mailing Address - Country:US
Mailing Address - Phone:918-649-0172
Mailing Address - Fax:888-753-8162
Practice Address - Street 1:448 36TH AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4746
Practice Address - Country:US
Practice Address - Phone:405-573-9905
Practice Address - Fax:405-701-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty