Provider Demographics
NPI:1477074896
Name:MILES, BELVA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BELVA
Middle Name:ANN
Last Name:MILES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 N KENMORE AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1380
Mailing Address - Country:US
Mailing Address - Phone:773-704-6249
Mailing Address - Fax:
Practice Address - Street 1:4236 N KENMORE AVE APT 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1380
Practice Address - Country:US
Practice Address - Phone:773-704-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical