Provider Demographics
NPI:1376829002
Name:MANYIBE, BENARD MAIRURA (LADC COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:BENARD
Middle Name:MAIRURA
Last Name:MANYIBE
Suffix:
Gender:M
Credentials:LADC COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S BOULEVARD APT 208
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4714
Mailing Address - Country:US
Mailing Address - Phone:419-378-2485
Mailing Address - Fax:
Practice Address - Street 1:930 S BOULEVARD APT 208
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4714
Practice Address - Country:US
Practice Address - Phone:419-378-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)