Provider Demographics
NPI:1144059619
Name:GATICA, MIRANDA MICHELLE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MICHELLE
Last Name:GATICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:M
Other - Last Name:SAMPSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:4226 WINDHURST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4539
Mailing Address - Country:US
Mailing Address - Phone:817-789-3267
Mailing Address - Fax:
Practice Address - Street 1:773 BANDIT TRL
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0111
Practice Address - Country:US
Practice Address - Phone:179-848-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician