Provider Demographics
NPI:1215359583
Name:MANUEL, COREY (LMHC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:MANUEL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FLORIDA CENTRAL PKWY
Mailing Address - Street 2:#1028
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-7651
Mailing Address - Country:US
Mailing Address - Phone:407-774-2284
Mailing Address - Fax:
Practice Address - Street 1:740 FLORIDA CENTRAL PKWY
Practice Address - Street 2:#1028
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7651
Practice Address - Country:US
Practice Address - Phone:407-774-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104965268OtherNPI FOR MENTAL HEALTH GROUP
FLMH 11048OtherFL DOH LICENSE
FL676458496OtherMEDWAIVER PROVIDER