Provider Demographics
NPI:1669978086
Name:MILES, DAVID NEIL (MSED, LPCC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NEIL
Last Name:MILES
Suffix:
Gender:M
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W TOLEDO ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2319
Mailing Address - Country:US
Mailing Address - Phone:218-206-4069
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHWAY 33 S STE 9B
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2665
Practice Address - Country:US
Practice Address - Phone:218-878-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty