Provider Demographics
NPI:1437240918
Name:MIRANDA-BRISTOL, DEBBIE LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LYNN
Last Name:MIRANDA-BRISTOL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1956
Mailing Address - Country:US
Mailing Address - Phone:714-543-6720
Mailing Address - Fax:714-519-3849
Practice Address - Street 1:680 LANGSDORF DR STE 219
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-543-6720
Practice Address - Fax:714-519-3849
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 22036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist