Provider Demographics
NPI:1629252747
Name:BLAEUER, MIRANDA CLAIRE (LMHC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CLAIRE
Last Name:BLAEUER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CLAIRE
Other - Last Name:MC MANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:705 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1111
Mailing Address - Country:US
Mailing Address - Phone:813-751-9644
Mailing Address - Fax:
Practice Address - Street 1:705 COLORADO ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1111
Practice Address - Country:US
Practice Address - Phone:813-751-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9248101YM0800X
TX81182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health