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General NPI Number Information
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NPI Number | 1487889390
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Entity Type | Individual
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Provider Name | TRACIE ADELE MILES MA LPC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 426 E. 5TH ST. 3RD FLOOR
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City | WASHINGTON
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State | MO
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Zip | 63090
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Country | US
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Telephone | 314-303-3602
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Fax | 636-293-1117
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Provider Business Mailing Address
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Address Line | 426 E. 5TH ST. 3RD FLOOR
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City | WASHINGTON
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State | MO
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Zip | 63090
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Country | US
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Telephone | 314-303-3602
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Fax | 636-293-1117
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2008035457
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2008036457
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License Number State | MO
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