Provider Demographics
NPI:1467059105
Name:MANNES, PAUL BENJAMIN (LPCC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BENJAMIN
Last Name:MANNES
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59922 LA BRISA DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-9351
Mailing Address - Country:US
Mailing Address - Phone:760-219-1386
Mailing Address - Fax:
Practice Address - Street 1:59922 LA BRISA DR
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-9351
Practice Address - Country:US
Practice Address - Phone:760-219-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4122101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor