Provider Demographics
NPI:1962828921
Name:IMAN-MILES, TERRI DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:DENISE
Last Name:IMAN-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 1:18 N 200 E
Mailing Address - Street 2:STE 311
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-1406
Mailing Address - Country:US
Mailing Address - Phone:410-375-6632
Mailing Address - Fax:
Practice Address - Street 1:18 N 200 E STE 311
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-1406
Practice Address - Country:US
Practice Address - Phone:410-375-6632
Practice Address - Fax:888-977-1509
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7789552-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical