Individual
TIM MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 N SECOND STREET, GRANTS, NM 87020
(505) 285-2614
(505) 287-8487
Mailing address
PO BOX 343, BLUEWATER, NM 87005-0343
(505) 287-4159
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
287256
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32408714
—
NM
Enumeration date
02/22/2007
Last updated
07/08/2007
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