Provider Demographics
NPI:1174965701
Name:MILES, ANTHONY ALLEN (PHD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALLEN
Last Name:MILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:ALLEN
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1221 S CLARKSON ST
Mailing Address - Street 2:#206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1625
Mailing Address - Country:US
Mailing Address - Phone:720-205-9752
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON ST
Practice Address - Street 2:#206
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1625
Practice Address - Country:US
Practice Address - Phone:720-205-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical