Provider Demographics
NPI:1679819486
Name:MILES, RAYMOND ADISON (LPCC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ADISON
Last Name:MILES
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4966
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8727
Practice Address - Country:US
Practice Address - Phone:606-523-8521
Practice Address - Fax:606-523-8742
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY173389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional