Miles, Mark A

Miles, Mark A is an individual health care provider with primary practice located at 332 N Lauderdale St , Memphis TN 38105-2794. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as his primary health care specialty. Miles, Mark A can be contacted via phone (901) 495-3006.

Contact Information

Primary practice address
332 N Lauderdale St Memphis TN 38105-2794
Phone: (901) 495-3006
Fax: (901) 495-3842
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 2302 Tennessee

Profile Details

NPI number 1053306159
LBN Legal business name Miles, Mark A
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2005
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053306159 NPPES
Tennessee MEDICAID 5440556

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