Provider Demographics
NPI:1780434399
Name:VENTURA, MIRANDA (LPC-A)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:VENTURA
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 AQUADUCT CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7744
Mailing Address - Country:US
Mailing Address - Phone:972-513-7790
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5712
Practice Address - Country:US
Practice Address - Phone:214-326-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional