Basic Information
| Provider Information | |||||||||
| NPI: | 1568655850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYLES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MAXWELL | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56765 FILE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 W THOMAS RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063473 | ||||||||
| FaxNumber: | 6024064406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 07/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3894 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.