Provider Demographics
NPI:1518394956
Name:MANN, FREDERICK (LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:LADC, LPCC
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 367
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-0367
Mailing Address - Country:US
Mailing Address - Phone:320-632-6647
Mailing Address - Fax:320-639-0014
Practice Address - Street 1:13 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1421
Practice Address - Country:US
Practice Address - Phone:218-928-8003
Practice Address - Fax:218-928-8006
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00743101YM0800X
MN303199101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health