Provider Demographics
NPI:1699010389
Name:MANZANARES, LORI ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:MANZANARES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E CARTER LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5391
Mailing Address - Country:US
Mailing Address - Phone:208-310-1192
Mailing Address - Fax:
Practice Address - Street 1:16 12TH AVE S, SUITE #103
Practice Address - Street 2:COOK TAFOYA FISHER BEHAVIORAL HEALTH
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3936
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional