Provider Demographics
NPI:1568763324
Name:MILESTONES
Entity Type:Organization
Organization Name:MILESTONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:925-286-6050
Mailing Address - Street 1:1620 N MAIN ST
Mailing Address - Street 2:SUTIE #1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4653
Mailing Address - Country:US
Mailing Address - Phone:925-286-6050
Mailing Address - Fax:925-937-6782
Practice Address - Street 1:1620 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4653
Practice Address - Country:US
Practice Address - Phone:925-286-6050
Practice Address - Fax:925-937-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16680103K00000X
251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty