Provider Demographics
NPI:1609154863
Name:MANNING, ANDREW (LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 W JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3986
Mailing Address - Country:US
Mailing Address - Phone:219-689-5333
Mailing Address - Fax:
Practice Address - Street 1:824 W JOLIET ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3986
Practice Address - Country:US
Practice Address - Phone:219-689-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200275200AMedicaid
IN200275200AMedicaid