Provider Demographics
NPI:1497071534
Name:MANHAL, JERI LYNNE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JERI
Middle Name:LYNNE
Last Name:MANHAL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 WILLIAMS DR.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-415-5549
Mailing Address - Fax:
Practice Address - Street 1:1618 WILLIAMS DR.
Practice Address - Street 2:SUITE 4
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-415-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215708101Y00000X
TX62113102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor