Provider Demographics
NPI:1821101551
Name:MILLER, EDWIN LEE JR (MDIV MHR LPC LMFT LA)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:LEE
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MDIV MHR LPC LMFT LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3133
Mailing Address - Country:US
Mailing Address - Phone:405-823-5608
Mailing Address - Fax:405-810-0331
Practice Address - Street 1:5208 CLASSEN CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4429
Practice Address - Country:US
Practice Address - Phone:405-848-2370
Practice Address - Fax:405-810-0331
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96101YA0400X
OK00101YP1600X
OK1424101YP2500X
OK714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist