Provider Demographics
NPI:1164981734
Name:MILES, WILLIAM DOUGLAS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-0178
Mailing Address - Country:US
Mailing Address - Phone:360-890-2601
Mailing Address - Fax:
Practice Address - Street 1:3033 INGRAM ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-4410
Practice Address - Country:US
Practice Address - Phone:360-890-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty