Provider Demographics
NPI:1053098095
Name:MILES, STEFANIE (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2246
Mailing Address - Country:US
Mailing Address - Phone:817-734-9432
Mailing Address - Fax:
Practice Address - Street 1:12740 HILLCREST RD STE 270
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2086
Practice Address - Country:US
Practice Address - Phone:214-487-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205057106H00000X
TX91250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist