Miracle Deysia Fan, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107417 Issued in TX

Practice address

26202 Oak Ridge Dr BLDG B204
Spring, TX 77380-1994

Phone

(346) 236-1123

NPI assigned

Sep 22, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miracle Betancourt Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1679524961
  Medicare reassignment NPD
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Pasadena, TX
  • NPI 1609762889
  NPD
• St Health TX, P.a.

  • Clinical Psychologist
  • New York, NY
  • NPI 1982476685
  NPD (past)

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1144943416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26202 OAK RIDGE DR BLDG B204",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773801994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26202 OAK RIDGE DR BLDG B204",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773801994",
            "telephone_number": "346-236-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "MIRACLE",
        "middle_name": "DEYSIA",
        "credential": "MSW,  LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-22",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "107417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRACLE",
            "last_name": "BETANCOURT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family American Medical Supply
• Family Help Counseling and Seminars, L.L.C.
• Family Wellness Physicians PLLC
• Familyfirstpediatrics, P.a.
• Hua-Nien Fan, AC
• Fana Realty Enterprise LLC (Aaxon)
• Fanar 1 Community Health
• Bingshuang Fang, M.D.
• Hayden Fanguy, DO
• Fariba Farajnejad

• Clinical Social Worker in Spring, TX
• Providers in Spring, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.