Provider Demographics
NPI:1003522780
Name:MANRIQUE, ANA KAREN (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:KAREN
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11313 GRANADOS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8956
Mailing Address - Country:US
Mailing Address - Phone:956-286-0312
Mailing Address - Fax:
Practice Address - Street 1:11313 GRANADOS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8956
Practice Address - Country:US
Practice Address - Phone:956-286-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14023101YA0400X
TX78991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16760145OtherDRIVER'S LICENSE