Provider Demographics
NPI:1376358267
Name:WAFFORD, MIRANDA MICHELLE (RBT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MICHELLE
Last Name:WAFFORD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9920 STARDUST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1316
Mailing Address - Country:US
Mailing Address - Phone:317-488-7189
Mailing Address - Fax:765-274-5260
Practice Address - Street 1:810 W 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1516
Practice Address - Country:US
Practice Address - Phone:765-617-2279
Practice Address - Fax:765-274-5260
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-189556106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician