Individual
MS. LYDIA MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPRSS
Contact information
Practice address
710 E SUTHERLAND ST, ALTUS, OK 73521-4041
(580) 477-2871
(580) 477-2870
Mailing address
710 E SUTHERLAND ST, ALTUS, OK 73521-4041
(580) 477-2871
(580) 477-2870
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
904208
OK
Other
Enumeration date
12/15/2009
Last updated
12/15/2009
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