Provider Demographics
NPI:1255601050
Name:TONYA L. MILES, PSYD, P.A.
Entity type:Organization
Organization Name:TONYA L. MILES, PSYD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:913-642-3134
Mailing Address - Street 1:11011 KING ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1213
Mailing Address - Country:US
Mailing Address - Phone:913-642-3134
Mailing Address - Fax:
Practice Address - Street 1:11011 KING ST
Practice Address - Street 2:SUITE 290
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1213
Practice Address - Country:US
Practice Address - Phone:913-642-3134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200297160BMedicaid