Provider Demographics
NPI:1215523568
Name:MIRANDA MEADOWS, P.C.
Entity type:Organization
Organization Name:MIRANDA MEADOWS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:601-319-3179
Mailing Address - Street 1:60 S RIVER ST APT 303
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-5137
Mailing Address - Country:US
Mailing Address - Phone:601-319-3179
Mailing Address - Fax:
Practice Address - Street 1:60 S RIVER ST APT 303
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5137
Practice Address - Country:US
Practice Address - Phone:601-319-3179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)