Provider Demographics
NPI:1366237307
Name:WILLIAMS, MIRACLE SHAPRE (LMFT)
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:SHAPRE
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 W FAWN DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7389
Mailing Address - Country:US
Mailing Address - Phone:626-841-1422
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4637
Practice Address - Country:US
Practice Address - Phone:626-841-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-16303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist