Provider Demographics
NPI:1558691576
Name:MILES, WILBERT LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:LEE
Last Name:MILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:MILES PH.D.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1839 YORK ST
Mailing Address - Street 2:#210 C/O (WILL MILES PHD) OR WILBERT L. MILES PH.D
Mailing Address - City:DENVER COUNTY
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1222
Mailing Address - Country:US
Mailing Address - Phone:303-321-9001
Mailing Address - Fax:303-494-1187
Practice Address - Street 1:1839 YORK ST
Practice Address - Street 2:#210 C/O (WILL MILES PHD) OR WILBERT L. MILES PH.D
Practice Address - City:DENVER COUNTY
Practice Address - State:CO
Practice Address - Zip Code:80206-1222
Practice Address - Country:US
Practice Address - Phone:303-321-9001
Practice Address - Fax:303-494-1187
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical