Provider Demographics
NPI:1427206531
Name:MANLEY, JEANETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1235 E. HARMONT DR.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-331-1470
Mailing Address - Fax:602-678-5803
Practice Address - Street 1:1235 E HARMONT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3864
Practice Address - Country:US
Practice Address - Phone:602-331-1470
Practice Address - Fax:602-678-5803
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-0860OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS