Provider Demographics
NPI:1720016769
Name:MILLER, RIETTA L (LCSW)
Entity Type:Individual
Prefix:
First Name:RIETTA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 720143
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4110
Mailing Address - Country:US
Mailing Address - Phone:405-831-6388
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:1818 W LINDSEY ST
Practice Address - Street 2:SUITE C-210
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4162
Practice Address - Country:US
Practice Address - Phone:405-831-6388
Practice Address - Fax:405-858-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707380AMedicaid
OK242309003Medicare PIN