Provider Demographics
NPI:1760147680
Name:SCHILLING, MIRANDA JORDAN (BEHAVIORAL TECH)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JORDAN
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3803
Mailing Address - Country:US
Mailing Address - Phone:760-596-7817
Mailing Address - Fax:
Practice Address - Street 1:125 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3803
Practice Address - Country:US
Practice Address - Phone:760-596-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician