Provider Demographics
NPI:1790069912
Name:MILLER, MARY KAY (BA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21801 TENTH PL
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047
Mailing Address - Country:US
Mailing Address - Phone:405-284-6230
Mailing Address - Fax:
Practice Address - Street 1:7777 E. HWY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:405-422-8821
Practice Address - Fax:405-262-1331
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health