Provider Demographics
NPI:1306981097
Name:MILES, CASSANDRA MCKINNON (LCMFT, LMFT, LCAC)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MCKINNON
Last Name:MILES
Suffix:
Gender:F
Credentials:LCMFT, LMFT, LCAC
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MCKINNON
Other - Last Name:CASSIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2398
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS722101YA0400X
MO2012040800106H00000X
CAMFC 48918106H00000X
KS2751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)