Provider Demographics
NPI:1649800624
Name:ADCOCK, MIRANDA MARIE (LPC, LCMHC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARIE
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9772 ELK RD
Mailing Address - Street 2:
Mailing Address - City:AXTELL
Mailing Address - State:TX
Mailing Address - Zip Code:76624-1545
Mailing Address - Country:US
Mailing Address - Phone:254-498-6388
Mailing Address - Fax:
Practice Address - Street 1:9772 ELK RD
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:TX
Practice Address - Zip Code:76624-1545
Practice Address - Country:US
Practice Address - Phone:254-498-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70687101YP2500X
NC14252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional