Healthcare Provider Details

I. General information

NPI: 1780571356
Provider Name (Legal Business Name): MR. THERIN MILLER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 S BOULEVARD # 240
EDMOND OK
73013-5308
US

IV. Provider business mailing address

3126 S BOULEVARD # 240
EDMOND OK
73013-5308
US

V. Phone/Fax

Practice location:
  • Phone: 405-301-0188
  • Fax:
Mailing address:
  • Phone: 405-301-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: