Healthcare Provider Details

I. General information

NPI: 1497083174
Provider Name (Legal Business Name): MIRANDA METCALF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N RAILROAD ST
MARLOW OK
73055-2221
US

IV. Provider business mailing address

602 SW 38TH ST
LAWTON OK
73505-6912
US

V. Phone/Fax

Practice location:
  • Phone: 580-641-1386
  • Fax:
Mailing address:
  • Phone: 580-248-5780
  • Fax: 580-353-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05827
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: