Healthcare Provider Details

I. General information

NPI: 1437240918
Provider Name (Legal Business Name): DEBBIE LYNN MIRANDA-BRISTOL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 219
FULLERTON CA
92831
US

IV. Provider business mailing address

900 MELODY LN
FULLERTON CA
92831-1956
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-6720
  • Fax: 714-519-3849
Mailing address:
  • Phone: 714-543-6720
  • Fax: 714-519-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 22036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: