Provider Demographics
NPI:1275154510
Name:MILES AHEAD COUNSELING
Entity Type:Organization
Organization Name:MILES AHEAD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:METLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-797-8377
Mailing Address - Street 1:145 S DURBIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2565
Mailing Address - Country:US
Mailing Address - Phone:307-797-8377
Mailing Address - Fax:833-300-9764
Practice Address - Street 1:145 S DURBIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2565
Practice Address - Country:US
Practice Address - Phone:307-797-8377
Practice Address - Fax:833-300-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY155663100Medicaid