Provider Demographics
NPI:1760267835
Name:LOUGH, MIRANDA J
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:LOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12513 WILLIAM PENN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3543
Mailing Address - Country:US
Mailing Address - Phone:580-209-2251
Mailing Address - Fax:
Practice Address - Street 1:901 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5764
Practice Address - Country:US
Practice Address - Phone:405-885-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health