Provider Demographics
NPI:1710298492
Name:MIDDLETON, MIRANDA (LPC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 GLEN DALE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3017
Mailing Address - Country:US
Mailing Address - Phone:720-373-9352
Mailing Address - Fax:
Practice Address - Street 1:777 S WADSWORTH BLVD
Practice Address - Street 2:BLDG#2, SUITE 205
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4300
Practice Address - Country:US
Practice Address - Phone:720-373-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional