Provider Demographics
NPI:1205408374
Name:MIRANDA, MELISSA (MA, NCC, LMFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MA, NCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 W STATE ROAD 426 STE 2008
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8389
Mailing Address - Country:US
Mailing Address - Phone:407-278-9983
Mailing Address - Fax:
Practice Address - Street 1:2572 W STATE ROAD 426 STE 2008
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-278-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist