Provider Demographics
NPI:1245486745
Name:MILES, NATHAN JARVIS (PHD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JARVIS
Last Name:MILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 BOONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9712
Mailing Address - Country:US
Mailing Address - Phone:859-940-6346
Mailing Address - Fax:
Practice Address - Street 1:4169 BOONE CREEK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9712
Practice Address - Country:US
Practice Address - Phone:859-379-9721
Practice Address - Fax:859-813-9244
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129918101YM0800X, 103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling