1104302579 NPI number — LISA P. MCMANUS, MS, LPC

Table of content: MELANIE STEPHENS CHANDLER CRNP (NPI 1770123242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104302579 NPI number — LISA P. MCMANUS, MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISA P. MCMANUS, MS, LPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104302579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36559-0062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-202-5655
Provider Business Mailing Address Fax Number:
251-202-5707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25369 US HIGHWAY 98 STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-4864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-202-5655
Provider Business Practice Location Address Fax Number:
251-202-5707
Provider Enumeration Date:
07/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCMANUS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
251-202-5655

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1506 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)