Organization
MILLENNIUM COMMUNITY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE L HAMIL PHD (CEO)
(405) 573-9905
Entity
Organization
Contact information
Practice address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(918) 649-0172
(918) 649-0315
Mailing address
3816 SHADOWRIDGE DR, NORMAN, OK 73072-5308
(405) 627-0276
(888) 753-8162
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200129170E
—
OK
Enumeration date
10/02/2013
Last updated
08/11/2019
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