Provider Demographics
NPI:1326209750
Name:JOHNS, MIRANDA HARRIS (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:HARRIS
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SPIRIT LAKE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5081
Mailing Address - Country:US
Mailing Address - Phone:863-258-6954
Mailing Address - Fax:
Practice Address - Street 1:4100 SPIRIT LAKE RD STE 4
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5081
Practice Address - Country:US
Practice Address - Phone:863-258-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLMH12769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator