Provider Demographics
NPI:1407180425
Name:BYRAM, MIRANDA ANN (MS, LMFT, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:ANN
Last Name:BYRAM
Suffix:
Gender:F
Credentials:MS, LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3569
Mailing Address - Country:US
Mailing Address - Phone:507-225-1500
Mailing Address - Fax:507-225-1501
Practice Address - Street 1:201 N BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3569
Practice Address - Country:US
Practice Address - Phone:507-225-1500
Practice Address - Fax:507-225-1501
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00800101YP2500X
MN1808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional