| Doctor Name: | MRS. DEEDRA LEIGH MCMILLIN |
| NPI Number: | 1215290929 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED, BHRS |
| License Number: | |
| Business Practice Address: | 801 E Main St Tishomingo, OK - 734602351 |
| Business Phone Number: | 5803713776 |
| Business Fax Number: | 5803712056 |
| Mailing Address: | 801 E Main St, TISHOMINGO |
| State: | OK |
| Postal Code: | 734602351 |
| Phone Number: | 5803713799 |
| Fax Number: | 5803712056 |
| NPI Enumeration Date: | 06/18/2012 |
| NPI Last Update Date: | 06/20/2012 |
| 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: | |