Provider Demographics
NPI:1972351831
Name:MILLER, MAGDELENE (LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:MAGDELENE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 S LEWIS AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5153
Mailing Address - Country:US
Mailing Address - Phone:918-205-4148
Mailing Address - Fax:
Practice Address - Street 1:4870 S LEWIS AVE STE 250
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5153
Practice Address - Country:US
Practice Address - Phone:918-205-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional