MEDICARE: MIRANDA MCDONALD

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
1	101YP2500X	Professional Counselor	04061	KS

General Provider Information

NPI Number	:	1740911379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA MCDONALD

Provider Business Mailing Address
First Line	:	1721 E OSAGE RD STE 100
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2198
Country	:	US
Telephone Number	:	316-247-3161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E OSAGE RD STE 300
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2290
Country	:	US
Telephone Number	:	316-247-3161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	04/28/2026

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Directions to “ MIRANDA MCDONALD ” Practice Location

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