Provider Demographics
NPI:1679685135
Name:MINER, PETER JAMES (MSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:MINER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8221 N ROCKWELL AVE
Mailing Address - Street 2:APT. 1116
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4254
Mailing Address - Country:US
Mailing Address - Phone:405-641-5177
Mailing Address - Fax:405-262-1331
Practice Address - Street 1:200 N CHOCTAW AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2624
Practice Address - Country:US
Practice Address - Phone:405-262-3209
Practice Address - Fax:405-262-1331
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health