Provider Demographics
NPI:1902924558
Name:MILEM, DAVID WESLEY (LPC & BCBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WESLEY
Last Name:MILEM
Suffix:
Gender:M
Credentials:LPC & BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4620
Mailing Address - Country:US
Mailing Address - Phone:512-550-3831
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 290
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6445
Practice Address - Country:US
Practice Address - Phone:512-550-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13966101YP2500X
1-13-13726103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0273302-01Medicaid