Provider Demographics
NPI:1720784820
Name:KUSCHEL, MIRANDA MAE
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MAE
Last Name:KUSCHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MINNESOTA DR STE 575
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5213
Mailing Address - Country:US
Mailing Address - Phone:612-223-8898
Mailing Address - Fax:612-223-8899
Practice Address - Street 1:3601 MINNESOTA DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5281
Practice Address - Country:US
Practice Address - Phone:612-223-8898
Practice Address - Fax:612-223-8899
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor