Provider Demographics
NPI:1609524552
Name:WARREN, MIRANDA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LYNN
Other - Last Name:FARTHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2571
Mailing Address - Country:US
Mailing Address - Phone:270-534-5128
Mailing Address - Fax:
Practice Address - Street 1:111 POPLAR ST STE 104
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2577
Practice Address - Country:US
Practice Address - Phone:270-534-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health