Provider Demographics
NPI:1023303070
Name:MIRANDA, INNAEL TODD (LAC, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:INNAEL
Middle Name:TODD
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:LAC, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 MORNINGSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6172
Mailing Address - Country:US
Mailing Address - Phone:720-230-3326
Mailing Address - Fax:
Practice Address - Street 1:1119 MORNINGSIDE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6172
Practice Address - Country:US
Practice Address - Phone:720-230-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-7097101YA0400X
NMCTB-2023-0229101YM0800X
COLPC.0020508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)