Provider Demographics
NPI:1902201841
Name:TRIGUEROS-THURSTON, MIRANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:TRIGUEROS-THURSTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30420 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8329
Mailing Address - Country:US
Mailing Address - Phone:661-414-2433
Mailing Address - Fax:
Practice Address - Street 1:27851 BRADLEY RD STE 111
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2213
Practice Address - Country:US
Practice Address - Phone:951-355-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist