Provider Demographics
NPI:1629667324
Name:MANFRE, VIVIANE
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:
Last Name:MANFRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CATRINA LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1576
Mailing Address - Country:US
Mailing Address - Phone:406-478-7834
Mailing Address - Fax:
Practice Address - Street 1:128 S 6TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4031
Practice Address - Country:US
Practice Address - Phone:406-478-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-TMP-48078101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor