MEDICARE: MARISSA ALEXANDRIA MILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184343022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ALEXANDRIA MILES

Provider Business Mailing Address
First Line	:	8300 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5654
Country	:	US
Telephone Number	:	888-922-2843
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5654
Country	:	US
Telephone Number	:	888-922-2843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	05/31/2026

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