Healthcare Provider Details

I. General information

NPI: 1992983423
Provider Name (Legal Business Name): MIRANDA RAE DARROW B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 W 4TH AVE
EUGENE OR
97401-2505
US

IV. Provider business mailing address

499 W 4TH AVE
EUGENE OR
97401-2505
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax:
Mailing address:
  • Phone: 541-686-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: