Provider Demographics
NPI:1215636147
Name:FANNING, MIRA ANN (MA, LPCC, MFTC)
Entity type:Individual
Prefix:
First Name:MIRA ANN
Middle Name:
Last Name:FANNING
Suffix:
Gender:F
Credentials:MA, LPCC, MFTC
Other - Prefix:
Other - First Name:MIRA ANN
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5687 S KING ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2826
Mailing Address - Country:US
Mailing Address - Phone:949-439-8836
Mailing Address - Fax:
Practice Address - Street 1:6087 S QUEBEC ST STE 102
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4539
Practice Address - Country:US
Practice Address - Phone:303-835-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health