Healthcare Provider Details

I. General information

NPI: 1205408374
Provider Name (Legal Business Name): MELISSA MIRANDA M.A., NCC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SELTEN WAY UNIT C
ORLANDO FL
32827-7933
US

IV. Provider business mailing address

9725 SELTEN WAY UNIT C
ORLANDO FL
32827-7933
US

V. Phone/Fax

Practice location:
  • Phone: 407-603-1598
  • Fax:
Mailing address:
  • Phone: 407-603-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: