Provider Demographics
NPI:1700077526
Name:MILES, LAURA DRU (LICENSED MARRIAGE AN)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:DRU
Last Name:MILES
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE AN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:MILES
Other - Last Name:VAHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 EAST SAN BERNARDINO ROAD
Mailing Address - Street 2:BUILDING E APT. 223
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791
Mailing Address - Country:US
Mailing Address - Phone:626-727-6058
Mailing Address - Fax:
Practice Address - Street 1:1350 EAST SAN BERNARDINO ROAD
Practice Address - Street 2:BUILDING E APT. 223
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-727-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health