Provider Demographics
NPI:1376966028
Name:MILES, DAVID W X (EDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:MILES
Suffix:X
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 STOW AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2521
Mailing Address - Country:US
Mailing Address - Phone:330-926-3800
Mailing Address - Fax:
Practice Address - Street 1:431 STOW AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2521
Practice Address - Country:US
Practice Address - Phone:330-926-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHKU1029136103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool