Provider Demographics
NPI:1922517374
Name:MILLER, CARRIE RENA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:RENA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:RENA
Other - Last Name:KRAJEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9404 BUTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9137
Mailing Address - Country:US
Mailing Address - Phone:405-496-0469
Mailing Address - Fax:
Practice Address - Street 1:9404 BUTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-9137
Practice Address - Country:US
Practice Address - Phone:405-237-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62141041C0700X
OK60651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200775820AMedicaid