MEDICARE: MIRANDA PHILLIPS MS, LPC

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	101YM0800X	Mental Health Counselor	LPC04966	AL

General Provider Information

NPI Number	:	1902680721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA PHILLIPS MS, LPC

Provider Business Mailing Address
First Line	:	76 BARNES DR
Second Line	:
City	:	ARITON
State	:	AL
Zip	:	36311-5058
Country	:	US
Telephone Number	:	334-402-1782
Fax Number	:

Provider Business Practice Location Address
First Line	:	6129 COUNTY ROAD 14
Second Line	:
City	:	MIDLAND CITY
State	:	AL
Zip	:	36350-4253
Country	:	US
Telephone Number	:	334-983-2020
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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