Provider Demographics
NPI:1679163935
Name:BOEHNE, MIRANDA (MS, LPCC)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:BOEHNE
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 HAZELTINE BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-395-1441
Mailing Address - Fax:952-395-1442
Practice Address - Street 1:1107 HAZELTINE BLVD STE 370
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1009
Practice Address - Country:US
Practice Address - Phone:952-395-1441
Practice Address - Fax:952-395-1442
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health