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General NPI Number Information
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NPI Number | 1700842911
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Entity Type | Individual
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Provider Name | DEBRA S. PITNER-MIRACLE LPC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 303 PEARL AVE SUITE C
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City | OSHKOSH
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State | WI
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Zip | 54901-4774
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Country | US
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Telephone | 920-233-4557
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Fax | 920-233-5644
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Provider Business Mailing Address
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Address Line | PO BOX 679
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City | OSHKOSH
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State | WI
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Zip | 54903-0679
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Country | US
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Telephone | 920-233-4557
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Fax | 920-233-5644
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2873-125
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License Number State | WI
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