Provider Demographics
NPI:1972346401
Name:NATHAN J MILES, THERAPY AND CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:NATHAN J MILES, THERAPY AND CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-379-9721
Mailing Address - Street 1:4169 BOONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9712
Mailing Address - Country:US
Mailing Address - Phone:859-379-9721
Mailing Address - Fax:859-813-9244
Practice Address - Street 1:4169 BOONE CREEK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9712
Practice Address - Country:US
Practice Address - Phone:859-379-9721
Practice Address - Fax:859-813-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty