Healthcare Provider Details

I. General information

NPI: 1003512187
Provider Name (Legal Business Name): MS. LATOYA MONIQUE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11232 NW 103RD ST
YUKON OK
73099-8275
US

IV. Provider business mailing address

11232 NW 103RD ST
YUKON OK
73099-8275
US

V. Phone/Fax

Practice location:
  • Phone: 405-641-4138
  • Fax:
Mailing address:
  • Phone: 405-836-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11592
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: