MEDICARE: STACY L MILES LCSW

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	104100000X	Social Worker	1701	KY

General Provider Information

NPI Number	:	1326152646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L MILES LCSW

Provider Business Mailing Address
First Line	:	101 W MUHAMMAD ALI BLVD
Second Line	:	HUMAN RESOURCES
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1423
Country	:	US
Telephone Number	:	502-589-1100
Fax Number	:	502-589-8771

Provider Business Practice Location Address
First Line	:	914 E BROADWAY
Second Line	:	SUITE 279
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1037
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:	502-589-8771

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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