Provider Demographics
NPI:1770273302
Name:GIDDINGS, MIRELLA (LMFT, APCC, ATR-P)
Entity type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:LMFT, APCC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 FM 78 UNIT 273
Mailing Address - Street 2:
Mailing Address - City:MC QUEENEY
Mailing Address - State:TX
Mailing Address - Zip Code:78123-0048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:197 E HAMILTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0261
Practice Address - Country:US
Practice Address - Phone:408-679-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8992101YP2500X
CA21-317221700000X
CA154648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist