Individual provider Active NPI

Innael Todd Miranda, LAC, LPC, LMHC

  • Mental Health Counselor
  • Albuquerque, NM
National Provider Identifier
1023303070
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC.0020508 Issued in CO
Practice address
1119 Morningside Dr NE
Albuquerque, NM 87110-6172
Phone
(720) 230-3326
NPI assigned
Jun 16, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ACC-7097 CO
Mental Health Counselor 101YM0800X CTB-2023-0229 NM
Mental Health Counselor 101YM0800X LPC.0020508 CO Primary

Addresses

Primary practice location

1119 Morningside Dr NE
Albuquerque, NM 87110-6172

Mailing address

1119 Morningside Dr NE
Albuquerque, NM 87110-6172
Phone (720) 230-3326

Other practice location 1

12101 E 2nd Ave
Suite 101
Aurora, CO 80011-8327
Phone (720) 670-7276

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250415001706 NM Practitioner - Mental Health Counselor 5597280370 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ACC-7097COMDAddiction (Substance Use Disorder) Counselor
LPC.0020508COMDMental Health Counselor
CTB-2023-0229NMMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Faith Works Counseling LLC CurrentSince Feb 11, 2025 Accepting new patients

Locations

8100 Wyoming Blvd NE
Ste M4
Albuquerque, NM 87113
Phone (505) 301-1105

7441 Bartlett St NE
Ste 1C
Albuquerque, NM 87109
Phone (505) 585-1263

221 N Auburn Ave
Farmington, NM 87401
Phone (505) 600-6631

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1023303070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 MORNINGSIDE DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871106172",
            "telephone_number": "720-230-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 MORNINGSIDE DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871106172",
            "telephone_number": "720-230-3326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12101 E 2nd Ave",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800118327",
            "country_code": "US",
            "telephone_number": "720-670-7276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "INNAEL",
        "middle_name": "TODD",
        "credential": "LAC, LPC, LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-16",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACC-7097",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2023-0229",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC.0020508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.