Provider Demographics
NPI:1235635756
Name:MANIE, MISTY D (LMFT, LCDC, SAP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:MANIE
Suffix:
Gender:F
Credentials:LMFT, LCDC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W HICKORY ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4150
Mailing Address - Country:US
Mailing Address - Phone:817-907-1060
Mailing Address - Fax:
Practice Address - Street 1:207 W HICKORY ST STE 210
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4150
Practice Address - Country:US
Practice Address - Phone:817-907-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10989101YA0400X
TX203066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty