Provider Demographics
NPI:1457411720
Name:MILLER, SCHELLE CODY (PHD INC)
Entity Type:Individual
Prefix:
First Name:SCHELLE
Middle Name:CODY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 24TH AVE NW
Mailing Address - Street 2:STE. 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6344
Mailing Address - Country:US
Mailing Address - Phone:405-801-2841
Mailing Address - Fax:405-801-2846
Practice Address - Street 1:1006 24TH AVE NW
Practice Address - Street 2:STE. 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6344
Practice Address - Country:US
Practice Address - Phone:405-801-2841
Practice Address - Fax:405-801-2846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK231425405Medicare ID - Type UnspecifiedPSYCHOLOGIST