Individual
MILES NITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
10515 ILLINOIS RD, FORT WAYNE, IN 46814-9182
(260) 373-9200
(260) 373-9219
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000572676
ANTHEM
IN
01
—
351972384007
TRICARE
IN
Enumeration date
06/19/2008
Last updated
11/15/2022
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