Provider Demographics
NPI:1477099273
Name:WALTON, MIRANDA DANIELLE (MA, LPCC-S)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DANIELLE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:DANIELLE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3103
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-3103
Mailing Address - Country:US
Mailing Address - Phone:740-214-6443
Mailing Address - Fax:888-626-6496
Practice Address - Street 1:58 N 5TH ST STE 102
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3527
Practice Address - Country:US
Practice Address - Phone:740-214-6443
Practice Address - Fax:888-626-6496
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.20011625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH413629Medicaid