Provider Demographics
NPI:1851154611
Name:NUNEZ, MIRANDA (MS)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:BASINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 DORRANCE ST
Mailing Address - Street 2:
Mailing Address - City:ELLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67637-2010
Mailing Address - Country:US
Mailing Address - Phone:785-829-0008
Mailing Address - Fax:
Practice Address - Street 1:409 DORRANCE ST
Practice Address - Street 2:
Practice Address - City:ELLIS
Practice Address - State:KS
Practice Address - Zip Code:67637-2010
Practice Address - Country:US
Practice Address - Phone:785-829-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor