Doctor Name: | MR. RAYMOND BRADLEY MCMILLIN |
NPI Number: | 1194088815 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BS,BHRS |
License Number: | |
Business Practice Address: | 801 E Main St Tishomingo, OK - 734602351 |
Business Phone Number: | 5803713799 |
Business Fax Number: | 5803712056 |
Mailing Address: | 122 Redbud Ln, POTEAU |
State: | OK |
Postal Code: | 749532040 |
Phone Number: | 9186471610 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 06/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |