Provider Demographics
NPI:1407601362
Name:MILLS, JUSTICE MARIA
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:MARIA
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:OK
Mailing Address - Zip Code:74339-1315
Mailing Address - Country:US
Mailing Address - Phone:918-325-0539
Mailing Address - Fax:
Practice Address - Street 1:10025 S 705 RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:OK
Practice Address - Zip Code:74370-9507
Practice Address - Country:US
Practice Address - Phone:918-303-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)