Provider Demographics
NPI:1669645412
Name:MIRANTE, MARK EDWARD (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:MIRANTE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6869 WOODLAWN AVE. NE, #114
Mailing Address - Street 2:SUITE #114
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-369-1103
Mailing Address - Fax:206-935-9967
Practice Address - Street 1:6869 WOODLAWN AVE. NE #114
Practice Address - Street 2:SUITE #114
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-369-1103
Practice Address - Fax:206-935-9967
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001328106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health