Provider Demographics
NPI:1922325950
Name:MILLER, BRENDA JOYCE (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOYCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7135
Mailing Address - Country:US
Mailing Address - Phone:918-335-1111
Mailing Address - Fax:918-335-1119
Practice Address - Street 1:2200 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7135
Practice Address - Country:US
Practice Address - Phone:918-335-1111
Practice Address - Fax:918-335-1119
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732190AMedicaid
OK100732190CMedicaid