Provider Demographics
NPI:1619447307
Name:LINVILLE, MIRANDA K (MA, LMHC CDP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:K
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:MA, LMHC CDP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:K
Other - Last Name:WINSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8606 ALLISONVILLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3585
Mailing Address - Country:US
Mailing Address - Phone:317-951-9358
Mailing Address - Fax:317-663-2524
Practice Address - Street 1:8606 ALLISONVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3585
Practice Address - Country:US
Practice Address - Phone:317-951-9358
Practice Address - Fax:317-663-2524
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002723A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39002723AOtherSTATE LICENSE