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NPI Code Detail

MEDICARE: MIRANDA CHICKLIS LMHC

MEDICARE: MIRANDA CHICKLIS LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0179741NM

General Provider Information

NPI Number : 1255852596
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA CHICKLIS LMHC
Provider Business Mailing Address
First Line : 125 RIDGECREST DR
Second Line :
City : SANTA FE
State : NM
Zip : 87505-6334
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4001 OFFICE COURT DR STE 102
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4903
Country : US
Telephone Number : 505-983-8225
Fax Number : 505-983-8225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2017
Last Update Date : 06/27/2017

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Directions to “ MIRANDA CHICKLIS LMHC” Practice Location

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