Healthcare Provider Details

I. General information

NPI: 1144365818
Provider Name (Legal Business Name): DIANE MILES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425A BURNET RD
AUSTIN TX
78756-1627
US

IV. Provider business mailing address

5659 WAGON TRAIN RD
AUSTIN TX
78749-2117
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-7337
  • Fax: 512-451-8729
Mailing address:
  • Phone: 512-663-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20277
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: