Provider Demographics
NPI:1932797354
Name:MILES, JESSICA LEANN (M ED LCPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEANN
Last Name:MILES
Suffix:
Gender:F
Credentials:M ED LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 N KNOB CREEK CT
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-0143
Mailing Address - Country:US
Mailing Address - Phone:208-661-1577
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 200L
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7575
Practice Address - Country:US
Practice Address - Phone:208-298-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional