Provider Demographics
NPI:1245990183
Name:SERVEY, MIRANDA
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:SERVEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 W ELDORADO PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-3540
Mailing Address - Country:US
Mailing Address - Phone:214-778-1153
Mailing Address - Fax:214-778-1153
Practice Address - Street 1:26919 US HIGHWAY 380 E STE 212
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-0239
Practice Address - Country:US
Practice Address - Phone:214-778-1153
Practice Address - Fax:214-778-1153
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX8100103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician