Provider Demographics
NPI:1770384174
Name:MILES, CRYSTAL RENEE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RENEE
Last Name:MILES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 GEORGE BROWN DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-6678
Mailing Address - Country:US
Mailing Address - Phone:469-358-9362
Mailing Address - Fax:
Practice Address - Street 1:6906 GEORGE BROWN DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-6678
Practice Address - Country:US
Practice Address - Phone:469-358-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician