Provider Demographics
NPI:1528498128
Name:GILES, MYLA MICHELLE (PHD, ACS, LPC)
Entity type:Individual
Prefix:DR
First Name:MYLA
Middle Name:MICHELLE
Last Name:GILES
Suffix:
Gender:F
Credentials:PHD, ACS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 DIVEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2801
Mailing Address - Country:US
Mailing Address - Phone:908-612-3350
Mailing Address - Fax:
Practice Address - Street 1:81 DIVEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2801
Practice Address - Country:US
Practice Address - Phone:908-612-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLPC37PC00089300101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ474699626Medicaid