Individual
MIRANDA CHICKLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4001 OFFICE COURT DR STE 102, SANTA FE, NM 87507-4903
(505) 983-8225
(505) 983-8225
Mailing address
125 RIDGECREST DR, SANTA FE, NM 87505-6334
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0179741
NM
Other
Enumeration date
06/27/2017
Last updated
06/27/2017
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