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General NPI Number Information
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NPI Number | 1417825100
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Entity Type | Individual
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Provider Name | DESTINY MILES
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Gender | Female
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Dates
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Enumeration Date | 10/25/2025
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Last Update Date | 10/25/2025
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Provider Practice Location Address
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Address Line | 201 KINGWOOD MEDICAL DR STE A450
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City | KINGWOOD
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State | TX
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Zip | 77339-6027
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Country | US
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Telephone | 210-447-0039
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Fax |
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Provider Business Mailing Address
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Address Line | 6222 W IH 10 STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78201-2013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-358110
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License Number State | TX
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