Provider Demographics
NPI:1174025324
Name:MANERS, RICHARD L (MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:MANERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6716
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6716
Mailing Address - Country:US
Mailing Address - Phone:435-760-6390
Mailing Address - Fax:
Practice Address - Street 1:502 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5548
Practice Address - Country:US
Practice Address - Phone:435-760-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-8310101YP2500X
UT13050268-6004101YP2500X
WYLPC-1895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional