Provider Demographics
NPI:1447630215
Name:MILLER, ASHLEY ELIZABETH (MSBS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SE 12TH ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7309
Mailing Address - Country:US
Mailing Address - Phone:580-695-9700
Mailing Address - Fax:
Practice Address - Street 1:715 SE 12TH ST UNIT 4
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7309
Practice Address - Country:US
Practice Address - Phone:580-695-9700
Practice Address - Fax:405-888-8959
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731545165Medicaid