Provider Demographics
NPI:1477106995
Name:MANRIQUE, NANCY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-0969
Mailing Address - Country:US
Mailing Address - Phone:208-678-3555
Mailing Address - Fax:208-678-3556
Practice Address - Street 1:531 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1469
Practice Address - Country:US
Practice Address - Phone:208-678-3555
Practice Address - Fax:208-678-3556
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health