Provider Demographics
NPI:1396928743
Name:MILLER, PENNY R (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:PENNY
Other - Middle Name:LUCILLE
Other - Last Name:ROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:5272 S LEWIS AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6563
Mailing Address - Country:US
Mailing Address - Phone:918-925-9137
Mailing Address - Fax:918-512-4272
Practice Address - Street 1:5272 S LEWIS AVE STE 132
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6563
Practice Address - Country:US
Practice Address - Phone:918-925-9137
Practice Address - Fax:918-512-4272
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor