Provider Demographics
NPI:1871811497
Name:MILLER, ANTOINETTE LORRAINE (BHRS)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:LORRAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:MISS
Other - First Name:ANTOINETTE
Other - Middle Name:LORRAINE
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHRS
Mailing Address - Street 1:227 E VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4132
Mailing Address - Country:US
Mailing Address - Phone:918-470-0896
Mailing Address - Fax:
Practice Address - Street 1:310 S. 11TH STREET
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547
Practice Address - Country:US
Practice Address - Phone:918-297-3400
Practice Address - Fax:918-297-3401
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health