Provider Demographics
NPI:1881051621
Name:PAULSON, MIRANDA KAY (MPS, LADC, LPCC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:PAULSON
Suffix:
Gender:
Credentials:MPS, LADC, LPCC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43747 250TH STREET
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431
Mailing Address - Country:US
Mailing Address - Phone:218-251-3719
Mailing Address - Fax:
Practice Address - Street 1:20 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1422
Practice Address - Country:US
Practice Address - Phone:218-326-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1816101YP2500X
MN304409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)