Healthcare Provider Details

I. General information

NPI: 1356538292
Provider Name (Legal Business Name): STEPHEN J MILLER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW EXPRESSWAY ST STE 900
OKLAHOMA CITY OK
73118-1802
US

IV. Provider business mailing address

1900 NW EXPRESSWAY ST STE 900
OKLAHOMA CITY OK
73118-1802
US

V. Phone/Fax

Practice location:
  • Phone: 405-810-1133
  • Fax: 405-810-1155
Mailing address:
  • Phone: 405-810-1133
  • Fax: 405-810-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number340
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number340
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number340
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number340
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number340
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number340
License Number StateOK

VIII. Authorized Official

Name: STEPHEN J MILLER
Title or Position: PRESIDENT
Credential: PHD
Phone: 405-810-1133