Provider Demographics
NPI:1376732495
Name:MILESTONES 4 LIFE LLC
Entity Type:Organization
Organization Name:MILESTONES 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCC
Authorized Official - Phone:614-596-5532
Mailing Address - Street 1:3400 N HIGH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1142
Mailing Address - Country:US
Mailing Address - Phone:614-596-5532
Mailing Address - Fax:
Practice Address - Street 1:3400 N HIGH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1142
Practice Address - Country:US
Practice Address - Phone:614-596-5532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1811195324OtherNPI