Provider Demographics
NPI:1437403458
Name:LIPSCOMB, MIRANDA RACHEL HARRIS (MS, PLPC)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:RACHEL HARRIS
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S INGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2835
Mailing Address - Country:US
Mailing Address - Phone:417-827-2878
Mailing Address - Fax:
Practice Address - Street 1:1531 E SUNSHINE ST
Practice Address - Street 2:SUITE W-29
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1240
Practice Address - Country:US
Practice Address - Phone:417-887-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012097391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health