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General NPI Number Information
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NPI Number | 1245286285
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL SERVICES, L.L.C.
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 448 36TH AVE NW STE 101
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City | NORMAN
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State | OK
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Zip | 73072-4743
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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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Provider Business Mailing Address
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Address Line | 508 MAN O WAR CT
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City | EDMOND
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State | OK
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Zip | 73025-9512
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Country | US
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Telephone | 405-623-0509
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Fax | 405-844-0729
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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 | 888-573-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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