Provider Demographics
NPI:1447019559
Name:MATTHEWS, MIRANDA J (MS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:J
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 REDDICK ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1669
Mailing Address - Country:US
Mailing Address - Phone:517-575-8745
Mailing Address - Fax:
Practice Address - Street 1:510 REDDICK ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1669
Practice Address - Country:US
Practice Address - Phone:517-575-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor