MEDICARE: MRS. EMMA ELIZABETH MILES LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10975	NY
2	101YP2500X	Professional Counselor	007153	MI

General Provider Information

NPI Number	:	1346230166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA ELIZABETH MILES LPC

Provider Business Mailing Address
First Line	:	119 S PEARL AVE
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3508
Country	:	US
Telephone Number	:	315-772-8801
Fax Number	:

Provider Business Practice Location Address
First Line	:	11050 MOUNT BELVEDERE BLVD
Second Line	:	ATTN: MCID-BH-CCC
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5438
Country	:	US
Telephone Number	:	315-772-6890
Fax Number	:	315-772-4097

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/11/2025

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