| Doctor Name: | MAILIN MIRANDA |
| NPI Number: | 1104202746 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LMHC 0173981 |
| Business Practice Address: | 717 W Abrahames Rd Ste D Moriarty, NM - 870358197 |
| Business Phone Number: | 5053840220 |
| Business Fax Number: | |
| Mailing Address: | 282 S Camino Del Pueblo Ste 2c, BERNALILLO |
| State: | NM |
| Postal Code: | 870045913 |
| Phone Number: | 5052883897 |
| Fax Number: | |
| NPI Enumeration Date: | 08/05/2015 |
| NPI Last Update Date: | 08/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LMHC 0173981 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |