Provider Demographics
NPI:1992184238
Name:MIRANDA, MICHELLE (LPC NCC MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LPC NCC MS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:30150 SW PARKWAY AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6837
Mailing Address - Country:US
Mailing Address - Phone:503-970-9042
Mailing Address - Fax:
Practice Address - Street 1:30150 SW PARKWAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-970-9042
Practice Address - Fax:503-217-0449
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4834101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health