Provider Demographics
NPI:1457887333
Name:MILES, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 KIETZKE LN STE O260
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5046
Mailing Address - Country:US
Mailing Address - Phone:775-200-0935
Mailing Address - Fax:775-440-1037
Practice Address - Street 1:4600 KIETZKE LN STE O260
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5046
Practice Address - Country:US
Practice Address - Phone:775-200-0935
Practice Address - Fax:775-440-1037
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23223103K00000X
NVLBA0517103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst