Healthcare Provider Details

I. General information

NPI: 1306727144
Provider Name (Legal Business Name): MIRANDA HURTADO-RAMOS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 LYONS AVE
HOUSTON TX
77020-8306
US

IV. Provider business mailing address

3811 LYONS AVE
HOUSTON TX
77020-8306
US

V. Phone/Fax

Practice location:
  • Phone: 409-242-2611
  • Fax:
Mailing address:
  • Phone: 409-242-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number116160
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: