Provider Demographics
NPI:1467821090
Name:MANLEY, JAMES MARK (MFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28999 OLD TOWN FRONT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2842
Mailing Address - Country:US
Mailing Address - Phone:951-830-7376
Mailing Address - Fax:
Practice Address - Street 1:28999 OLD TOWN FRONT ST STE 105
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2842
Practice Address - Country:US
Practice Address - Phone:951-830-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT31446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist