Basic Information
| Provider Information | |||||||||
| NPI: | 1679685135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8221 N ROCKWELL AVE | ||||||||
| Address2: | APT. 1116 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731324254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056415177 | ||||||||
| FaxNumber: | 4052621331 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N CHOCTAW AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730362624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052623209 | ||||||||
| FaxNumber: | 4052621331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.