Provider Demographics
NPI:1003816091
Name:MANUEL, LEANNA ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:ELAINE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 RESEARCH PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2851
Mailing Address - Country:US
Mailing Address - Phone:937-431-3870
Mailing Address - Fax:937-431-3871
Practice Address - Street 1:1321 RESEARCH PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2851
Practice Address - Country:US
Practice Address - Phone:937-431-3870
Practice Address - Fax:937-431-3871
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311588267OtherTRICARE
OH2261421Medicaid
OH311588267OtherTRICARE