1710920152 NPI number — MRS. DEBRA MAXTON MILLER MHR, LPC

Table of content: MRS. DEBRA MAXTON MILLER MHR, LPC (NPI 1710920152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710920152 NPI number — MRS. DEBRA MAXTON MILLER MHR, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
DEBRA
Provider Middle Name:
MAXTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MHR, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAXTON
Provider Other First Name:
DEBRA
Provider Other Middle Name:
FAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710920152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 S. MAIN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AFTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-961-0422
Provider Business Mailing Address Fax Number:
918-961-0422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 S. MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AFTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-961-0422
Provider Business Practice Location Address Fax Number:
918-961-0422
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2931 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2931 . This is a "OK ST. DEPT. OF HEALTH - LIC. PROFESSIONAL COUNSELOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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