Individual
DR. LOUISE E. MIRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP, INC.
Contact information
Practice address
2525 W. VERNAL PIKE, BLOOMINGTON, IN 47404
(812) 339-4877
(812) 339-4877
Mailing address
P.O. BOX 3155, BLOOMINGTON, IN 47402
(812) 339-4877
(812) 339-4877
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040642A
IN
Other
Enumeration date
07/14/2006
Last updated
09/25/2008
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