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General NPI Number Information
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NPI Number | 1013309616
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Entity Type | Organization
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Legal Business Name | MILLENNIUM COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 312 N VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-4500
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Country | US
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Telephone | 580-297-5125
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Fax | 580-297-5126
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Provider Business Mailing Address
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Address Line | 3816 SHADOWRIDGE DR
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City | NORMAN
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State | OK
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Zip | 73072-5308
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Country | US
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Telephone | 888-573-7792
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Fax | 888-753-8162
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Authorized Official
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Title or Position | CEO
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Name | DR. WADE L HAMIL
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Credential | PHD
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Telephone | 405-573-9905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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