Provider Demographics
NPI:1992126361
Name:MILES, KATE ZANDRA (LMSW, CCTP)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ZANDRA
Last Name:MILES
Suffix:
Gender:F
Credentials:LMSW, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11233 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1638
Mailing Address - Country:US
Mailing Address - Phone:913-522-6575
Mailing Address - Fax:
Practice Address - Street 1:11233 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1638
Practice Address - Country:US
Practice Address - Phone:913-522-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7289104100000X
MO2012018973104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker