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General NPI Number Information
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NPI Number | 1699270314
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Entity Type | Individual
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Provider Name | MIRANDA TELLEZ
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 1012 24TH AVE NW STE 100
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City | NORMAN
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State | OK
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Zip | 73069-6493
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Country | US
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Telephone | 855-223-7123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 740780
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City | ATLANTA
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State | GA
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Zip | 30374-0780
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Country | US
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Telephone | 855-223-7123
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Fax | 619-374-7134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12496479-2506
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-35225
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7535
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-35225
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License Number State | OK
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