MEDICARE: MR. EDWIN LEE MILLER JR. MDIV MHR LPC LMFT LA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	96	OK
2	101YP1600X	Pastoral Counselor	00	OK
3	101YP2500X	Professional Counselor	1424	OK
4	106H00000X	Marriage & Family Therapist	714	OK

General Provider Information

NPI Number	:	1821101551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWIN LEE MILLER JR. MDIV MHR LPC LMFT LA

Provider Business Mailing Address
First Line	:	3300 N VERMONT AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3133
Country	:	US
Telephone Number	:	405-823-5608
Fax Number	:	405-810-0331

Provider Business Practice Location Address
First Line	:	5208 CLASSEN CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-4429
Country	:	US
Telephone Number	:	405-848-2370
Fax Number	:	405-810-0331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/21/2025

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