Individual
EDMUND M MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LAC, LPC
Contact information
Practice address
5350 TOMAH DR STE 3600, COLORADO SPRINGS, CO 80918-6991
(970) 310-3406
Mailing address
10755 ELIZABETH WAY, COLORADO SPRINGS, CO 80908-1532
(719) 722-4756
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0000479
CO
101YP2500X
Professional Counselor
Primary
LPC.0012699
CO
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/28/2012
Last updated
09/23/2022
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