Provider Demographics
NPI:1114604378
Name:BATTLE, MIRANDA BLAIZE (MS, LAC, CTP)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:BLAIZE
Last Name:BATTLE
Suffix:
Gender:F
Credentials:MS, LAC, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 W BELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9522
Mailing Address - Country:US
Mailing Address - Phone:623-977-0677
Mailing Address - Fax:
Practice Address - Street 1:12211 W BELL RD STE 205
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9522
Practice Address - Country:US
Practice Address - Phone:623-977-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health