Provider Demographics
NPI:1194217109
Name:MILES, AMY A (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:MILES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W62 N248 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE#207
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2765
Mailing Address - Country:US
Mailing Address - Phone:262-375-1116
Mailing Address - Fax:262-375-1071
Practice Address - Street 1:W62 N248 WASHINGTON AVENUE
Practice Address - Street 2:SUITE#207
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2765
Practice Address - Country:US
Practice Address - Phone:262-375-1116
Practice Address - Fax:262-375-1071
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6831-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional