Provider Demographics
NPI:1164038659
Name:SCHREIBER, MIRANDA (CPC-I)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:ASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5627 STOMPING BOOTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2076
Mailing Address - Country:US
Mailing Address - Phone:412-992-7708
Mailing Address - Fax:
Practice Address - Street 1:7310 SMOKE RANCH RD STE S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0260
Practice Address - Country:US
Practice Address - Phone:702-456-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health