Healthcare Provider Details

I. General information

NPI: 1912301854
Provider Name (Legal Business Name): RACHEL MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N MOON AVE
BRANDON FL
33510-4419
US

IV. Provider business mailing address

135 N MOON AVE
BRANDON FL
33510-4419
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-8828
  • Fax:
Mailing address:
  • Phone: 813-689-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: