Provider Demographics
NPI:1417092503
Name:MCMANAMAN, KATHLEEN MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MCMANAMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5860 S PECOS RD
Mailing Address - Street 2:BLDG G STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-5428
Mailing Address - Country:US
Mailing Address - Phone:702-538-9474
Mailing Address - Fax:702-834-8437
Practice Address - Street 1:5860 S PECOS RD
Practice Address - Street 2:BLDG G STE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5428
Practice Address - Country:US
Practice Address - Phone:702-538-9474
Practice Address - Fax:702-834-8437
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner