Provider Demographics
NPI:1710555719
Name:MIRANDA EDWARDS MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:MIRANDA EDWARDS MENTAL HEALTH LLC
Other - Org Name:MIRANDA EDWARDS MENTAL HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-778-1544
Mailing Address - Street 1:9662 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-3282
Mailing Address - Country:US
Mailing Address - Phone:720-778-1544
Mailing Address - Fax:
Practice Address - Street 1:9351 GRANT ST STE 480
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4375
Practice Address - Country:US
Practice Address - Phone:720-778-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health