Healthcare Provider Details

I. General information

NPI: 1750220745
Provider Name (Legal Business Name): MIRANDA PADILLA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 ANDALUSIAN LN
ROBINSON TX
76706-6200
US

IV. Provider business mailing address

3005 ANDALUSIAN LN
ROBINSON TX
76706-6200
US

V. Phone/Fax

Practice location:
  • Phone: 254-339-4254
  • Fax: 254-339-4254
Mailing address:
  • Phone: 254-339-4254
  • Fax: 254-339-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: