Provider Demographics
NPI:1518384767
Name:GILES, MAILE T (LMFT, LCDC)
Entity Type:Individual
Prefix:MS
First Name:MAILE
Middle Name:T
Last Name:GILES
Suffix:
Gender:F
Credentials:LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 BROADWAY
Mailing Address - Street 2:#226
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-860-7633
Mailing Address - Fax:
Practice Address - Street 1:5108 BROADWAY
Practice Address - Street 2:#226
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-860-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11169101YA0400X
TX201685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)