Provider Demographics
NPI:1346989167
Name:MIRELES, SANDRA DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:MIRELES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 LONG DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-1003
Mailing Address - Country:US
Mailing Address - Phone:832-578-2873
Mailing Address - Fax:713-970-7246
Practice Address - Street 1:5901 LONG DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-1003
Practice Address - Country:US
Practice Address - Phone:713-970-7000
Practice Address - Fax:713-970-7246
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68031101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty