Healthcare Provider Details

I. General information

NPI: 1710555719
Provider Name (Legal Business Name): MIRANDA EDWARDS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 GRANT ST STE 480
THORNTON CO
80229-4375
US

IV. Provider business mailing address

9662 BIRCH LN
THORNTON CO
80229-3282
US

V. Phone/Fax

Practice location:
  • Phone: 720-778-1544
  • Fax:
Mailing address:
  • Phone: 720-778-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA EDWARDS
Title or Position: THERAPIST
Credential: LPC
Phone: 720-778-1544