Healthcare Provider Details

I. General information

NPI: 1326190158
Provider Name (Legal Business Name): MARGO MILES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S 600 E STE 10D
SALT LAKE CITY UT
84102-1961
US

IV. Provider business mailing address

607 ELIZABETH ST
SALT LAKE CITY UT
84102-3905
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-9204
  • Fax: 801-582-1392
Mailing address:
  • Phone: 801-328-9204
  • Fax: 801-582-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number369759-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: