Healthcare Provider Details

I. General information

NPI: 1265920847
Provider Name (Legal Business Name): MILESTONES BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 08/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 MAJORCA LOOP
MYRTLE BEACH SC
29579
US

IV. Provider business mailing address

552 MAJORCA LOOP
MYRTLE BEACH SC
29579-8004
US

V. Phone/Fax

Practice location:
  • Phone: 845-625-8248
  • Fax:
Mailing address:
  • Phone: 845-625-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA FARAH
Title or Position: BCBA/OWNER
Credential:
Phone: 843-449-0554