Provider Demographics
NPI:1265445332
Name:MANUEL, BILLY JOE (NCC LPC)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:JOE
Last Name:MANUEL
Suffix:
Gender:M
Credentials:NCC LPC
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 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:26 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 720101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
138373OtherANTHEM PROF TRIGON
334969OtherVALUE OPTIONS GROUP
019OtherCHAMPUS TRICARE
3085402OtherMAGELLAN NAVIGATOR
3085402OtherMAGELLAN SUMMIT
3085402OtherMAGELLAN PINNACLE