Provider Demographics
NPI:1114381852
Name:ANN-MARIE MANNING PSYCHOTHERAPY PRACTICE
Entity Type:Organization
Organization Name:ANN-MARIE MANNING PSYCHOTHERAPY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPIETER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-393-5673
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0713
Mailing Address - Country:US
Mailing Address - Phone:719-393-5673
Mailing Address - Fax:
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 102F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3345
Practice Address - Country:US
Practice Address - Phone:719-393-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099243071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty