Provider Demographics
NPI:1033164983
Name:MILES, LAURIE ANN
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:MILES
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4852 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1727
Mailing Address - Country:US
Mailing Address - Phone:615-373-1981
Mailing Address - Fax:615-216-2172
Practice Address - Street 1:4852 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1727
Practice Address - Country:US
Practice Address - Phone:615-373-1981
Practice Address - Fax:615-216-2172
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN218811OtherCOMPSYCH CORPORATION
TN4602650OtherAETNA
TN4062246OtherBLUE CROSS/BLUE SHIELD
TN42-866619OtherUNITED HEALTHCARE
TN2284094OtherAETNA LIFE INSURANCE, TX
TN4062246OtherBLUE CROSS/BLUE SHIELD