Provider Demographics
NPI:1942682620
Name:MIRACLE COUNSELING AND LIFE COACHING, LLC
Entity Type:Organization
Organization Name:MIRACLE COUNSELING AND LIFE COACHING, LLC
Other - Org Name:MIRACLE COUNSELING AND LIFE COACHING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:LILIAN
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC- PSYD
Authorized Official - Phone:920-889-7200
Mailing Address - Street 1:8440 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1734
Mailing Address - Country:US
Mailing Address - Phone:414-405-1682
Mailing Address - Fax:414-979-6449
Practice Address - Street 1:8440 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-1734
Practice Address - Country:US
Practice Address - Phone:414-405-1682
Practice Address - Fax:414-979-6449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE COUNSELING AND LIFE COACHING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-18
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043588619OtherPROFESSIONAL NPI
WI101YP2500XMedicaid