Basic Information
Provider Information
NPI: 1295844041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCFALL
FirstName: MILES
MiddleName: EMERY
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1660 S COLUMBIAN WAY
Address2: 116MHC
City: SEATTLE
State: WA
PostalCode: 981081532
CountryCode: US
TelephoneNumber: 2067642177
FaxNumber: 2067642572
Practice Location
Address1: 1660 S COLUMBIAN WAY
Address2: 116MHC
City: SEATTLE
State: WA
PostalCode: 981081532
CountryCode: US
TelephoneNumber: 2067642177
FaxNumber: 2067642572
Other Information
ProviderEnumerationDate: 08/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X861WAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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