Provider Demographics
NPI:1689275810
Name:MILESTONE MARRIAGE AND FAMILY THERAPY SERVICES PROFESSIONAL CORPORATI
Entity Type:Organization
Organization Name:MILESTONE MARRIAGE AND FAMILY THERAPY SERVICES PROFESSIONAL CORPORATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-284-4504
Mailing Address - Street 1:3491 CONCOURS STE 202
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5927
Mailing Address - Country:US
Mailing Address - Phone:909-284-4504
Mailing Address - Fax:909-259-1428
Practice Address - Street 1:3491 CONCOURS STE 202
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5927
Practice Address - Country:US
Practice Address - Phone:909-284-4504
Practice Address - Fax:909-259-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty