Healthcare Provider Details

I. General information

NPI: 1568763324
Provider Name (Legal Business Name): MILESTONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 05/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N MAIN ST SUITE #1
WALNUT CREEK CA
94596-4653
US

IV. Provider business mailing address

1620 N MAIN ST SUTIE #1
WALNUT CREEK CA
94596-4653
US

V. Phone/Fax

Practice location:
  • Phone: 925-286-6050
  • Fax: 925-937-6782
Mailing address:
  • Phone: 925-286-6050
  • Fax: 925-937-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number16680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACIE VICKERS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 925-286-6050