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General NPI Number Information
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NPI Number | 1417837717
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Entity Type | Organization
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Legal Business Name | MIRANDA BABL LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 5303 E JELINEK AVE
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City | WESTON
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State | WI
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Zip | 54476-4230
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Country | US
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Telephone | 715-574-9628
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 MCADDOE PL
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City | KRONENWETTER
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State | WI
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Zip | 54455-8109
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Country | US
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Telephone | 715-574-9628
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MIRANDA TINA MARTHA BABL
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Credential | LPC
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Telephone | 715-574-9628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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