Provider Demographics
NPI:1083293369
Name:SHURLEY, MIRANDA L (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:SHURLEY
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BELFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4808
Mailing Address - Country:US
Mailing Address - Phone:214-770-4861
Mailing Address - Fax:
Practice Address - Street 1:4400 N MIDLAND DR STE 2910
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3385
Practice Address - Country:US
Practice Address - Phone:432-400-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84575101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health