Provider Demographics
NPI:1982805982
Name:LOUCKS, MIRANDA LORRAINE (COUNSELING INTERN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LORRAINE
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:COUNSELING INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N SUMMIT BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1571
Mailing Address - Country:US
Mailing Address - Phone:509-325-7667
Mailing Address - Fax:509-325-7675
Practice Address - Street 1:820 N SUMMIT BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1571
Practice Address - Country:US
Practice Address - Phone:509-325-7667
Practice Address - Fax:509-325-7675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057287101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor