Provider Demographics
NPI:1861261703
Name:MILES, OWEN ANDREW (CDCA)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:ANDREW
Last Name:MILES
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:ANDREW
Other - Last Name:ECKENRODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCAP
Mailing Address - Street 1:528 W MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1085
Mailing Address - Country:US
Mailing Address - Phone:419-947-4560
Mailing Address - Fax:
Practice Address - Street 1:528 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1085
Practice Address - Country:US
Practice Address - Phone:419-947-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.191461101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator