Miranda Puente, BSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12789 Issued in CO

Practice address

2521 4TH Ave
Pueblo, CO 81003-1704

Phone

(719) 778-4237

NPI assigned

May 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1164096285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 4TH AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810031704",
            "telephone_number": "719-778-4237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 4TH AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810031704",
            "telephone_number": "719-778-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUENTE",
        "first_name": "MIRANDA",
        "credential": "BSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "12789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "12789",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "1",
            "affiliation": "N",
            "endpointDescription": "personal phone",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2521 4th Ave",
            "city": "Pueblo",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810031704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pueblo Speech and Neurological Rehabilitation Center
• Pueblo Sports and Family Medicine PLLC
• Pueblo Vascular Diagnostics, Inc
• Pueblo Womens Center
• Pueblo Womens Center, LLC
• Kaitlyn Pullara
• Theodore Joseph Puls, M.D.
• Pura Vida Voices, LLP
• Pure Infusion of Colorado LLC
• Ambar Alejandra Pylant

• Mental Health Counselor in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.