Provider Demographics
NPI:1922541606
Name:MILES, PAISLEY L (LCSW)
Entity Type:Individual
Prefix:
First Name:PAISLEY
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E BROADWAY ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4566
Mailing Address - Country:US
Mailing Address - Phone:406-207-2680
Mailing Address - Fax:
Practice Address - Street 1:126 E BROADWAY ST STE 11
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4566
Practice Address - Country:US
Practice Address - Phone:406-471-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MTBBH-LCSW-LIC-375951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical