MEDICARE: MIRANDA HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	35002269A	IN

General Provider Information

NPI Number	:	1013620566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA HARRIS

Provider Business Mailing Address
First Line	:	6424 SPY GLASS RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9417 SAINT JOE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-9474
Country	:	US
Telephone Number	:	260-370-6573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	12/29/2022

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Directions to “ MIRANDA HARRIS ” Practice Location

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