Provider Demographics
NPI:1285432690
Name:MILES, SONATA
Entity type:Individual
Prefix:
First Name:SONATA
Middle Name:
Last Name:MILES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 TYBALT CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5119
Mailing Address - Country:US
Mailing Address - Phone:317-658-8670
Mailing Address - Fax:
Practice Address - Street 1:9165 OTIS AVE STE 242
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2317
Practice Address - Country:US
Practice Address - Phone:317-658-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health