Healthcare Provider Details

I. General information

NPI: 1154911469
Provider Name (Legal Business Name): YENESSA D MIRANDA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 W PARK AVE
REDLANDS CA
92373-8014
US

IV. Provider business mailing address

1812 W PARK AVE
REDLANDS CA
92373-8014
US

V. Phone/Fax

Practice location:
  • Phone: 909-748-0259
  • Fax:
Mailing address:
  • Phone: 909-748-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: