Provider Demographics
NPI:1235580440
Name:MANIX, LEAH ROMERO (LMFT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROMERO
Last Name:MANIX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:674 HAMBLET RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9506
Mailing Address - Country:US
Mailing Address - Phone:619-339-0034
Mailing Address - Fax:
Practice Address - Street 1:1600 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:619-339-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health