Individual
MIRANDA LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 3 MILE ROAD NW SUITE 200, GRAND RAPIDS, MI 49544-1691
(616) 469-3870
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
MI
103K00000X
Behavior Analyst
Primary
7401002203
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
11/10/2020
Last updated
10/06/2025
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