Provider Demographics
NPI:1962683904
Name:MILLER, LESLIE A
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:
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 913
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-0913
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:580-254-5335
Practice Address - Street 1:1213 W HANKS TRL
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-7601
Practice Address - Country:US
Practice Address - Phone:580-254-5322
Practice Address - Fax:580-254-5335
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor