Provider Demographics
NPI:1437699543
Name:MANIFESTING EXCELLENCE LLC
Entity Type:Organization
Organization Name:MANIFESTING EXCELLENCE LLC
Other - Org Name:MELLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRAWLEY-MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS
Authorized Official - Phone:614-626-8464
Mailing Address - Street 1:6100 CHANNINGWAY BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2910
Mailing Address - Country:US
Mailing Address - Phone:614-626-8464
Mailing Address - Fax:614-626-8809
Practice Address - Street 1:6100 CHANNINGWAY BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2910
Practice Address - Country:US
Practice Address - Phone:614-694-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH964511251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0174232Medicaid