Provider Demographics
NPI:1013318823
Name:SCHUNK, MIRANDA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:SCHUNK
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41385 US HIGHWAY 71, PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-3197
Mailing Address - Country:US
Mailing Address - Phone:507-831-2090
Mailing Address - Fax:507-831-0185
Practice Address - Street 1:41385 US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-3197
Practice Address - Country:US
Practice Address - Phone:507-831-2090
Practice Address - Fax:507-831-0185
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health