Provider Demographics
NPI:1164933214
Name:MILES, CARSON WIDMER (LPC)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:WIDMER
Last Name:MILES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10577 TIGERS EYE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9567
Mailing Address - Country:US
Mailing Address - Phone:303-596-8586
Mailing Address - Fax:
Practice Address - Street 1:5690 DTC BLVD STE 120W
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3255
Practice Address - Country:US
Practice Address - Phone:303-596-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional