Individual
DIEGO JULIAN MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1047 S WELLS ST STE 107, MERIDIAN, ID 83642-7997
(208) 702-1889
Mailing address
1047 S WELLS ST STE 107, MERIDIAN, ID 83642-7997
(208) 646-1077
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10507
ID
Other
Enumeration date
05/20/2024
Last updated
08/28/2024
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