Provider Demographics
NPI:1558641076
Name:MANRIQUE, ENRIQUE (LCDC, LPC-I)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:LCDC, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 ARTIC CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8417
Mailing Address - Country:US
Mailing Address - Phone:956-791-6647
Mailing Address - Fax:
Practice Address - Street 1:1857 ARTIC CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8417
Practice Address - Country:US
Practice Address - Phone:956-791-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9616101YA0400X
TX66765101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health