Provider Demographics
NPI:1205324332
Name:HOLZBAUER-BEARSS, MIRANDA (MA, LPC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HOLZBAUER-BEARSS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8932 HANALEI CIR
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3698
Mailing Address - Country:US
Mailing Address - Phone:989-390-1514
Mailing Address - Fax:
Practice Address - Street 1:1520 29TH AVE STE 25
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:228-382-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health