Healthcare Provider Details

I. General information

NPI: 1053046599
Provider Name (Legal Business Name): MIRIAM MCLEOD RAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 CORIANDA CT NW
ALBUQUERQUE NM
87104-3267
US

IV. Provider business mailing address

2619 CORIANDA CT NW
ALBUQUERQUE NM
87104-3267
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-0223
  • Fax: 505-212-6618
Mailing address:
  • Phone: 505-239-0223
  • Fax: 505-212-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1611
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: