Provider Demographics
NPI:1053067330
Name:MCMANAMY, MELISSA ANNE (MS, LPC-T)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:MCMANAMY
Suffix:
Gender:F
Credentials:MS, LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1275
Mailing Address - Country:US
Mailing Address - Phone:816-668-6262
Mailing Address - Fax:
Practice Address - Street 1:4061 INDIAN CREEK PARKWAY, SUITE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-6620
Practice Address - Country:US
Practice Address - Phone:913-444-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04018T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLPC04018TOtherLICENSE - TEMP #