Most Relevant Information
Provider Data
| NPI Number: | 1003473893 |
| Provider Name: | MIRANDA GORGES |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/28/2019 |
| Last Updated: | 05/28/2019 |
Provider Practice Location
16200 19 MILE RD
CLINTON TOWNSHIP
MI
480381103
Practice Location Phone/Fax
| Phone: | 5862768000 |
| Fax: |
Provider Mailing Location
16200 19 MILE RD
CLINTON TOWNSHIP
MI
480381103
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |