Provider Demographics
NPI:1578817789
Name:MANESS, KRISTA (LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MANESS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3441
Mailing Address - Country:US
Mailing Address - Phone:406-213-3432
Mailing Address - Fax:
Practice Address - Street 1:455 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3441
Practice Address - Country:US
Practice Address - Phone:406-213-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health