Provider Demographics
NPI:1003079484
Name:ALLEN-MILES, MARTHA S (MFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:ALLEN-MILES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARTIE
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:975 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8704
Mailing Address - Country:US
Mailing Address - Phone:818-986-2420
Mailing Address - Fax:818-986-2420
Practice Address - Street 1:975 FLYNN RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8704
Practice Address - Country:US
Practice Address - Phone:805-388-7740
Practice Address - Fax:805-482-0987
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist