Provider Demographics
NPI:1609455872
Name:MANNABA COUNSELING GROUP
Entity Type:Organization
Organization Name:MANNABA COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-274-3549
Mailing Address - Street 1:380 SEMORAN COMMERCE PL STE B202
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4684
Mailing Address - Country:US
Mailing Address - Phone:407-753-1473
Mailing Address - Fax:407-703-9078
Practice Address - Street 1:380 SEMORAN COMMERCE PL STE B202
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4684
Practice Address - Country:US
Practice Address - Phone:407-753-1473
Practice Address - Fax:407-703-9078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANNABA COUNSELING CENTER AND TRAINING INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-05
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty