Miracle Farm, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

68824 Issued in TX

Legal business name

MIRACLE FARM, INC.

Practice address

10802 FM 2621
Brenham, TX 77833-0164

Phone

(979) 836-0901

Fax

(979) 277-0939

NPI assigned

Sep 8, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Jay Alexander Hamilton

Title

Executive Director

Phone

(979) 836-0901

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Robert Fuller II, LPC-S

  • Professional Counselor
  • College Station, TX
  • NPI 1952845240
  NPD (past)

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679091789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10802 FM 2621",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "778330164",
            "telephone_number": "979-836-0901",
            "fax_number": "979-277-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 FM 2621",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "778330164",
            "telephone_number": "979-836-0901",
            "fax_number": "979-277-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE FARM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "979-836-0901",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "TX",
            "license": "68824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Bright DDS PA
• Michelle Hung Raney PLLC
• Heather A Mikeska, MD
• Kathy Milenki, CCC-SLP
• Susan C Miller, MD
• Jessica Lynn Gemina Mohr, PA-C
• Mario Alejandro Molina Condal, PSY.D
• Celene Marie Layda Morales, CF-SLP
• Victoria B. Morgan, MD
• Frances Muench, PTA

• Voluntary or Charitable Agency in Brenham, TX
• Providers in Brenham, TX by specialty
• Voluntary or Charitable Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.