Basic Information
| Provider Information | |||||||||
| NPI: | 1649608910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16650 SHERMAN WAY STE 202 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188552270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8215 VAN NUYS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188552270 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 120009 | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 225400000X- | 01 | CA | OTHER | OTHER |