Provider Demographics
NPI:1144586850
Name:MIRANDA WHITE, MARY G
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:MIRANDA WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10859 W 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1306
Mailing Address - Country:US
Mailing Address - Phone:720-485-7945
Mailing Address - Fax:
Practice Address - Street 1:8671 WOLFF CT
Practice Address - Street 2:SUITE 220-C
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3609
Practice Address - Country:US
Practice Address - Phone:720-485-7945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor