Healthcare Provider Details

I. General information

NPI: 1679819486
Provider Name (Legal Business Name): RAYMOND ADISON MILES LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8521
  • Fax: 606-523-8742
Mailing address:
  • Phone: 502-253-4966
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number173389
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: