MEDICARE: PREISZ MCMILLIN CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	132	OK

General Provider Information

NPI Number	:	1316066749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREISZ MCMILLIN CLINIC INC

Provider Business Mailing Address
First Line	:	3629 NW 51ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-848-4244
Fax Number	:	405-601-3750

Provider Business Practice Location Address
First Line	:	3629 NW 51ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-848-4244
Fax Number	:	405-601-3750

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	DEBRA J PARRISH
Credential	:
Telephone Number	:	405-601-0954

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/31/2011

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