Provider Demographics
NPI:1881190882
Name:BELSHER, MIRANDA (MS, LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:BELSHER
Suffix:
Gender:F
Credentials:MS, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7454
Mailing Address - Country:US
Mailing Address - Phone:503-547-5344
Mailing Address - Fax:
Practice Address - Street 1:6409 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7454
Practice Address - Country:US
Practice Address - Phone:415-489-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61089389103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty