Provider Demographics
NPI:1457934135
Name:HUESMAN, MIRANDA FAYE (LPC, LPCC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:FAYE
Last Name:HUESMAN
Suffix:
Gender:
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:FRERICHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 WESTRAC DR S STE 400
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2356
Mailing Address - Country:US
Mailing Address - Phone:701-960-9867
Mailing Address - Fax:651-925-0057
Practice Address - Street 1:1202 WESTRAC DR S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2356
Practice Address - Country:US
Practice Address - Phone:701-960-9867
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1119-5-1-21-572101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional