Provider Demographics
NPI:1083050397
Name:MIRANDA, MEGAN LYNN (LPCC-S, IMFT-S)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LYNN
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LPCC-S, IMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1900
Mailing Address - Country:US
Mailing Address - Phone:330-510-4900
Mailing Address - Fax:330-510-5900
Practice Address - Street 1:2795 FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1900
Practice Address - Country:US
Practice Address - Phone:330-510-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200639-SUPV101YM0800X, 101YP2500X, 101Y00000X
OHOH3108465101YS0200X
OHF.1400021-SUPV106H00000X
OHM.1200040106H00000X
OHC.1200639-CR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255723Medicaid