Provider Demographics
NPI:1295382299
Name:STAFFEN, MIRIAM JOYCE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:JOYCE
Last Name:STAFFEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:JOYCE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1363 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3392
Mailing Address - Country:US
Mailing Address - Phone:208-736-7090
Mailing Address - Fax:
Practice Address - Street 1:1363 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3392
Practice Address - Country:US
Practice Address - Phone:208-736-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional