Provider Demographics
NPI:1730577933
Name:MILLER, JADEA ALACIA
Entity type:Individual
Prefix:
First Name:JADEA
Middle Name:ALACIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADEA
Other - Middle Name:
Other - Last Name:DABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7408 S. ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-853-1463
Mailing Address - Fax:
Practice Address - Street 1:1 W 36TH ST N STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1703
Practice Address - Country:US
Practice Address - Phone:918-425-4200
Practice Address - Fax:918-425-4202
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK173057933Medicaid