Healthcare Provider Details

I. General information

NPI: 1780956771
Provider Name (Legal Business Name): ANGELA Y KEMP-MILLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MFT ARDMORE CLINIC 2510 CHICKASAW BLVD.
ARDMORE OK
73401
US

IV. Provider business mailing address

MFT ARDMORE CLINIC 2510 CHICKASAW BLVD.
ARDMORE OK
73401
US

V. Phone/Fax

Practice location:
  • Phone: 580-222-2884
  • Fax: 580-564-3605
Mailing address:
  • Phone: 580-222-2884
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1190
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1190
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: