Miranda Chicklis, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0179741 Issued in NM

Practice address

4001 Office Court Dr Ste 102
Santa Fe, NM 87507-4903

Phone

(505) 983-8225

Fax

(505) 983-8225

NPI assigned

Jun 27, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Earth Spirit Awakenings LLC

  • Community/Behavioral Health Agency
  • Santa Fe, NM
  • NPI 1447490800
  NPD (past)

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498521600000",
    "number": "1255852596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 RIDGECREST DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875056334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 OFFICE COURT DR STE 102",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875074903",
            "telephone_number": "505-983-8225",
            "fax_number": "505-983-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHICKLIS",
        "first_name": "MIRANDA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2017-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0179741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnnetta M Chester
• Melanie V Chevarie, LM
• Kerrilyn Chew, D.O.M.
• Victoria Chew, DO
• Robert T Chiarito, DDS
• Nicholas David Chignoli, LMSW
• Child Counseling Center and Play Therapy Institute of New Mexico
• Josiah H Child, M.D.
• Children, Youth & Families Dept.-Protective Services
• Children'S Medical Services

• Mental Health Counselor in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2017; 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.