Organization Name: | MILLENNIUM MEDICAL SERVICES |
NPI Number: | 1518210285 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WADE L HAMIL (CEO) |
Mailing Address: | 520 W Rogers Blvd Skiatook |
State: | OK US |
Postal Code: | 740701061 |
Phone Number: | 8885737792 |
Fax Number: | 8887538162 |
NPI Enumeration Date: | 10/18/2012 |
NPI Last Update Date: | 08/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 0785 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |